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

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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)


Objective 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. Conclusion 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
Publication statusPublished - 1 Jan 2018


  • Patient education
  • Rheumatoid arthritis
  • Health services needs and demands
  • n/a OA procedure


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