RESEARCH - Facilitating the use of COBRA combination therapy in early RA: a pilot implementation study

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J Rheumatol. 2009 Jun 1.

Facilitating the Use of COBRA Combination Therapy in Early Rheumatoid

Arthritis: A Pilot Implementation Study.

van Tuyl LH, Plass AM, Lems WF, Voskuyl AE, Kerstens PJ, Dijkmans BA, Boers M.

From the Department of Rheumatology, EMGO Institute, and the

Department of Epidemiology and Biostatistics, VU University Medical

Center; and Jan van Breemen Institute, Amsterdam, The Netherlands.

OBJECTIVE: COBRA combination therapy is well known and has uncontested

efficacy in the treatment of rheumatoid arthritis (RA). However, it is

infrequently applied in Dutch clinical practice. Based on qualitative

research on opinions of physicians and patients towards COBRA therapy,

our study describes the development and pilot testing of an

implementation package to facilitate prescription and use of COBRA

therapy in early RA.

METHODS: The implementation package was developed to address specific

barriers towards prescription of COBRA therapy and comprised

informational handouts (an information booklet and leaflet for

patients), preprinted prescription orders, and background information

on COBRA therapy for the rheumatologists. Twenty-two rheumatologists

agreed to participate, including the arthritis nurse where available.

Rheumatologists, nurses, and patients were asked to record their

experience. All Dutch arthritis nurses were invited to an educational

session on COBRA therapy.

RESULTS: Sixteen rheumatologists accompanied by 10 arthritis nurses

used the material to prescribe COBRA therapy to a total of 27

patients. Rheumatologists and nurses both gave high marks to the

supplied materials. Eighty-eight percent of rheumatologists reported

that the material sped up the prescription process, and 65% indicated

they would prescribe COBRA therapy more frequently if these materials

were available routinely. Patients expressed great satisfaction with

the information handouts, rating it 2.8 (standard deviation 0.5) on a

scale of -3 (very negative) to +3 (very positive). Most patients (89%)

planned to keep the information booklet as a reference and 70% used it

as a tool to remember the correct intake of medication. The attitude

and perceived capability of nurses towards the guidance of patients

with RA receiving COBRA therapy was improved through a brief

educational intervention.

CONCLUSION: Rheumatologists, patients, and arthritis nurses all highly

appreciated the implementation package and indicated that its

availability would increase uptake of COBRA therapy.

PMID: 19487259

http://www.ncbi.nlm.nih.gov/pubmed/19487259

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