O19 Shifting Perceptions: The Role of the Rheumatologist when Commencing a Patient with Rheumatoid Arthritis on Methotrexate
MTX is the recommended first-line treatment for RA. Treatment response to this drug is not universal and nonadherence may partially explain this. The extended Common-Sense Self-Regulatory Model of Illness (CS-SRM) is increasingly used in rheumatology because it helps to explain variations in outcome by highlighting relationships between people's beliefs about their condition and treatments and their coping responses, such as intentional non-adherence. The Perceptions and Practicalities Model
... M) of adherence further recognizes that patient barriers to adherence need to be addressed in order for optimal medicine adherence to occur. Therefore the rheumatologist has a key role in shaping patients' illness and treatment beliefs and identifying possible barriers, but very little is known about how rheumatologists address these issues in routine practice. This qualitative study aimed to explore UK rheumatologists' experiences and practice when commencing MTX with new patients. Methods: In-depth one-to-one semi-structured telephone interviews were conducted with 15 rheumatologists who prescribe MTX for RA. The sampling strategy ensured collection of data from new and experienced clinicians working in university and district general hospitals. The interview topic guide included rheumatologists' perceptions of RA, MTX and their role in management of the disease; factors influencing MTX use (e.g. patient alcohol use, family planning) and the information provided to patients. Data were analyzed using principles of framework analysis in which key concepts from CS-SRM and PPM were used to identify clinicians' beliefs and strategies. Results: Rheumatologists perceived MTX as their preferred first-line treatment for RA, however, they described a range of psychological, clinical and practical barriers to effective MTX adherence. Patient focused barriers included information overload, emotional preparedness for treatment and patients' understanding of RA. Rheumatologists provided a range of strategies used to address or minimize barriers. Strategies for less-prepared patients included delaying MTX commencement, referring for nurse-led 'education' or counselling. Strategies to improve patients' understanding of the rationale for MTX included the use of disease-related metaphors. Rheumatologists' responses to diagnostic uncertainty included selection of an alternative DMARD. Conclusion: Through in-depth qualitative study of rheumatologists' experiences in prescribing MTX, a number of new issues were identified that may impact clinical practice. The results suggest the manner and timing of information delivery about MTX affect patient beliefs and adherence intentions. These findings will inform an online survey to further explore the association between rheumatologists' beliefs and strategies in the management of RA with MTX. Disclosure statement: The authors have declared no conflicts of interest.