New data shows that Australian rheumatologists are trusted by their patients, particularly around biologics.
Australian rheumatology patients have positive attitudes towards biologic and targeted synthetic DMARDs and a high degree of trust in their rheumatologist, according to ARAD research published in Rheumatology Advances in Practice.
Almost 1500 patients from the Australian Rheumatology Association Database (ARAD) with rheumatoid arthritis, psoriatic arthritis or axial spondyloarthritis were invited to take part in a survey looking at patient attitudes to biologic and targeted synthetic (b/ts) DMARDs, biosimilars and sources of information regarding medication and treatment choices.
“A consistent finding throughout the study, as in previous studies, was that patients had a high level of confidence and trust in their rheumatologist to provide information and advice on treatment decisions,” the authors wrote.
“Higher levels of trust in the physician, along with active patient participation, has been shown to lead to better patient outcomes in rheumatological diseases.”
Two thirds (994) of those invited completed the survey, and of these about two thirds were women and the median age was 63 years.
Most (80%) were currently taking b/tsDMARDs, with many of these on their first one. Among those not taking a b/tsDMARD, almost half had previously taken them but stopped, mainly due to loss of efficacy.
Among patients taking a b/tsDMARD, there was a strong belief in the necessity for it, reflected in a high BMQ (brief medication questionnaire) ‘necessity’ score. Concerns about it, including overuse and harms, were generally low.
While most patients (up to 82%) weren’t aware of biosimilars, they were generally willing to consider it if recommended by their rheumatologist.
When asked about sources of information on b/tsDMARDs, respondents reported consulting several sources, with rheumatologists being the main source (99% of patients). Educational websites and GPs were a distant second and third, with almost half of patients consulting them.
Websites such as Google or Wikipedia, pharmacists and rheumatology nurses were other key sources of information, consulted by at least a third of patients, with chat rooms, social media, friends/relatives and other patients rounding out the list of sources.
There was a wide range in how the information was perceived, with almost all information from rheumatologists regarded as positive, and educational websites, GPs, rheumatology nurses, pharmacists and other websites also mainly positive. There was more uncertainty around social media, other media, chat rooms and relatives/friends.
Overall, however, there was high satisfaction with information obtained.
Sources varied among different patient groups, with younger patients more likely to consult a range of information sources and people with lower health literacy more likely to consult GPs and pharmacists.
Attitudes towards medication also affected choice of sources, and people with medication concerns were more likely to consult friends, social media, chat rooms and so on – potentially sources of misinformation. They were also less satisfied with the information obtained.
“It was unclear if the survey participants understood that information from some of these sources was potentially unreliable, but there was considerable uncertainty in their perception of what this information meant,” the authors wrote.
“Patients will benefit from improved education about best medication information sources and how to appropriately address conflicting medication information.”
The strengths of this study were the high response rate with well-characterised participants from all over Australia.
Limitations related to how representative the findings were of the patient group as a whole. Compared with the rheumatic disease community more broadly, the ARAD cohort has lower rates of low health literacy, high rates of b/tsDMARD use, indicative of moderate-severe disease, and were likely more actively engaged with their disease.
“Australian patients with RA, PsA and axSpA have positive attitudes towards b/tsDMARDs overall,” the authors concluded, “although little knowledge of biosimilars specifically.
“They consult a number of information sources but have a high degree of trust in their rheumatologist with regard to treatment decisions, even if they are unfamiliar with the medication recommended.”
