BACKGROUND: A recent study showed low adherence to the published treatment guidelines for axial spondyloarthritis (axSpA) / ankylosing spondylitis (AS). The aim of this study was to determine barriers to guideline adoption that are specific to axSpA / AS.
METHODS: A systematic literature review was conducted to learn which general barriers to guideline adoption have been proposed in the literature. A second systematic literature review was conducted to identify strategies to increase response rates in the deployment of electronic surveys. A survey was developed based on the findings from the literature, aimed to interrogate the perspective of rheumatologists on barriers within their practice. A focus group was conducted to gain insight from experts in the field.
RESULTS: The SLR identified 22 primary research articles on barriers to guideline adherence in axSpA / AS, almost all of which focused on drug therapy or physical therapy / exercise. Only 1 of the 22 studies was conducted in the US. The SLR on survey deployment methods identified 52 articles, 40 of which included sufficient information to calculate response rates. The mean response rate for online surveys distributed to rheumatologists was 0.33 with no statistically significant differences between surveys that contacted physicians once, twice or three or more times. From the literature, a framework was synthesized that captures relevant barriers to guideline adherence in 5 categories: guideline factors, health professional factors, patient factors, practice setting factors and societal factors. A survey was drafted, with questions targeting each of the five categories included in the framework. Suggestions from the experts participating in the focus group resulted in a revised survey consisting of 33 questions. Additionally, the focus group proposed ideas for survey dissemination, including strong support for the utilization of social media in addition to email invitations.
CONCLUSION: The literature on barriers to guideline adherence in axSpA / AS is limited, in particular in the domains of disease activity monitoring, osteoporosis screening / monitoring, and other non-pharmacologic therapies. Only a single US study on barriers to guideline adherence in axSpA / AS was identified, indicating the need for more research in this field. The focus group provided firsthand perspective, allowing for modification of the survey to capture the most informative data. The focus group also provided insight into survey dissemination methods and ideas to maximize participation. The SLR on electronic survey deployment suggests an expected response rate of 0.33 for surveys administered to rheumatologists via email.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/43356 |
| Date | 11 November 2021 |
| Creators | Forte, Alexandra |
| Contributors | Dubreuil, Maureen, Ermann, Joerg |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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