Patient’s access to healthcare and treatment in rheumatoid arthritis: the views of stakeholders in Portugal

Abstract

BackgroundThe access to healthcare and treatment by rheumatoid arthritis (RA) patients, particularly to biologics, differs significantly among European countries.We aimed to explore the views and experiences of Portuguese healthcare stakeholders on key barriers which limit the access to treatment, and ultimately to biologics, by RA patients and to find potential solutions (leverage points) to overcome the identified barriers.MethodsThis was a qualitative research consisting of semi-structured face-to-face interviews with key stakeholders in RA framework. Thirty four individuals from eight groups of stakeholders were interviewed: rural and urban general practitioners (GPs), rheumatologists, hospital managers, hospital pharmacists, budget holders, representatives from the Portuguese Rheumatology Society and the RA Patient Association. Interviews were conducted between May and June 2011. Conventional content analysis with research triangulation was used.ResultsThe key barriers identified were related to the accessibility to primary healthcare services, difficulties in RA diagnosis among GPs, inefficient referral to secondary healthcare and controlled process of biologics prescription in public hospitals. The leverage points identified included the improvement of epidemiological and clinical knowledge about RA in Portugal, a better understanding of the disease among patients and GPs, the clarification of biologics benefits among budget holders and a raised awareness of the current treatment guidelines. In order to further address the leverage points, the following key initiatives were proposed: optimization of RA national registry; dissemination of information on rheumatic symptoms in primary care facilities and among the general public; increase interaction between rheumatologists and GPs through clinical discussions of successfully treated patients or workshops; broader utilization of disease diagnosis and monitoring tools, such as DAS28, and implementation of hospital–based research to collect real-world data.ConclusionsMost of the key barriers limiting the access to treatment, including biologics, in RA in Portugal are upstream of rheumatology practice. Our findings suggest that future actions should be focused on the primary care level to improve referral to rheumatologists. In addition, the collection of real-world data seems essential to characterise the RA population, to improve disease management and to increase compliance with current treatment guidelines.

Biological Therapies in Immune-Mediated Inflammatory Diseases: Can Biosimilars Reduce Access Inequities?

“…Furthermore, a relationship between patient access and the biologics distribution channel was also observed, with lower usage of biologics being correlated with a higher proportion of biologics being dispensed in hospitals compared with other settings (Laires et al, 2013a). In a study in Portugal (a country with low biologics usage relative to the European average in 2013), key barriers that limited access to biologics were related to the accessibility of primary healthcare services, difficulties in RA diagnosis among general practitioners, inefficient referral to secondary healthcare, and the controlled process of biologics prescriptions in public hospitals (Laires et al, 2013b). Administrative hurdles and limited numbers of prescribers were also shown to be barriers to access to biologics in Central and Eastern European countries (Orlewska et al, 2011).…”

A general practice perspective on early rheumatoid arthritis management: A qualitative study from Flanders

“…Furthermore, they could play an important role in the follow-up of the early RA treatment as prescribed by the rheumatologists. Nevertheless, little is known about GPs' interactions with patients with early RA and their experiences, beliefs and attitudes concerning the management of early RA (15)(16)(17)(18). Furthermore, to our knowledge, the beliefs and behavioural intentions of GPs about intensive treatment initiation remain unknown.…”

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“…Hospital care is more expensive than the procedures performed at a physician's office, an outpatient center or at home (17,18). The financial advantages of home care in Romanian RA patients needs further investigation, but the intangible costs related to quality of life for both patients and families should also be considered in such analyses.…”