The standards of care for rheumatoid arthritis: importance and current implementation according to patients and healthcare providers in the Netherlands

Monika Hifinger, Sofia Ramiro, Polina Putrik, Yvonne van Eijk-Hustings, Anthony Woolf, Josef S Smolen, Michaela Stoffer-Marx, Tillman Uhlig, Rikke Helene Moe, Merdan Saritas, Marian Janson, Annette van der Helm-van Mil, Mart van de Laar, Harald Vonkeman, Maarten de Wit, Annelies Boonen

Research output: Contribution to journalArticleAcademicpeer-review


OBJECTIVES: The standards of care (SOCs) for rheumatoid arthritis (RA) aimed to improve quality of care across Europe. This study investigated importance and implementation of each standard according to patients and health care professionals (HCPs) in the Netherlands and identified barriers towards implementation.

METHODS: Dutch patients, rheumatologists and rheumatology nurses rated importance and implementation (0-10 numeric rating scale (NRS); 10=most important/best implemented) for each of the 20 SOCs. A care gap, adjusted for importance, was calculated: (100=highest gap). Statistical differences between a) patients and HCPs and b) subgroups of patients (demographics, health) were tested. Additionally, patients indicated agreement (0-10) with 6 implementation barriers.

RESULTS: 386 patients and 91 HCPs were included. Both ranked adequate disease modifying anti-rheumatic drug treatment (9.3(SD1.2), 9.2(SD0.8)), access to care in emergencies (9.2(SD1.2), 9.2(SD1.0)) and regular re-appraisal when treatment fails (9.2(SD1.3), 9.0(SD1.0)) the most important SOCs, and these were among the best implemented (NRS≥8.5) SOCs. After accounting for applicability, patients and HCP identified care gaps for early diagnosis (25.5(SD32.0), 22.3(SD16.3)), availability of a treatment plan (25.1(SD22.7), 25.7(SD18.5)) and patients also for a regular schedule of assessment of disease (28.6(SD25.5)).Patients with poorer health or higher education scored systematically lower on care received while sharing similar priorities. Patients and HCPs considered limited reimbursement of specific health services a main barrier for implementation and patients additionally identified limited time of physicians.

CONCLUSIONS: Dutch patients and HCPs overall agreed on priorities in care and found relevant SOCs well implemented. However, suggestions for improvement were raised especially by patients with poorer health and/or higher education.

Original languageEnglish
Pages (from-to)275-283
Number of pages9
JournalClinical and Experimental Rheumatology
Issue number2
Early online date15 Dec 2017
Publication statusPublished - 1 Jan 2018

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