LONDON, ON - As many of us know, old habits die hard; doctors are no exception. When assessing and managing Rheumatoid Arthritis (RA), many physicians provide good care but don’t always follow practice guidelines. Between time constraints and patient reluctance to change medications, there is often a gap between theory and practice, resulting in gaps in patient care. While it can be challenging for physicians to alter their behavior, a new study suggests it is a viable possibility. Dr. Janet Pope, Scientist and rheumatologist at Lawson Health Research Institute, and colleagues have found that a brief educational intervention may alter physician behavior in the assessment and management of RA.

At the beginning of a six-month assessment period, 20 rheumatologists were each asked to complete chart audits for 50 RA patients. The audit process asked physicians to complete one page forms logging basic criteria such as demographic information, drug use, and musculoskeletal measurements. Upon completion, 10 of the physicians were randomly assigned to complete a six-month educational intervention. Through monthly hour-long web-based conferences, this group was taught the importance of systematically assessing RA patients and treating to a target of a low disease state, focusing on new strategies for measurement, best practices, and eliminating barriers to care. They were also provided with the results of their own chart audits, as well as those of their peers. In the meantime, the remaining 10 physicians were given no intervention and offered no feedback. At the end of the six-month period, all 20 physicians completed another round of chart audits and the results were significant.

Those physicians who did not participate in the educational intervention demonstrated little to no changes. Physicians who did participate, however, demonstrated significant behavior improvements. After the educational intervention, this group demonstrated a 30% improvement in systematic measurements and more treatment changes for patients who were not having low RA disease activity. This is the first study of its kind to link rheumatologists’ educational intervention to a direct change in behavior. These results indicate that learning in small groups using feedback from practice audits may be an inexpensive way to improve outcomes in patients with RA.

“Even when rheumatologists are doing a good job, they can do even better if they know where they stand in the assessment and treatment of RA patients,” Dr. Pope explains. “More patients will be in a better disease state in practices that incorporate systematic assessment and physician behavioral change. We hope to develop a standardized RA follow up form for Ontario rheumatologists that would have all the necessary components for targeting care, and could easily be incorporated into paper and electronic medical records.”

This study is currently being rolled out on a national level to assess rheumatologists across Canada. The educational intervention was an accredited program through the Schulich School of Medicine & Dentistry at The University of Western Ontario. Funding was provided through an educational grant from Abbott Canada.

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Lawson Health Research Institute. As the research institute of London Health Sciences Centre and St. Joseph's Health Care, London, and working in partnership with The University of Western Ontario, Lawson Health Research Institute is committed to furthering scientific knowledge to advance health care around the world. www.lawsonresearch.com

Sonya Gilpin
Communications & Public Relations
Lawson Health Research Institute
519-685-8500 ext. 75852
sonya.gilpin@lawsonresearch.com
www.lawsonresearch.com