Premium
Qualitative Exploration of Triangulated, Shared Decision‐Making in Rheumatoid Arthritis
Author(s) -
BinderFinnema Pauline,
Dzurilla Kathryn,
Hsiao Betty,
Fraenkel Liana
Publication year - 2019
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23801
Subject(s) - rheumatoid arthritis , medicine , qualitative research , patient participation , health insurance , health care , family medicine , social science , sociology , economics , economic growth
Objective Treat‐to‐target implementation in rheumatoid arthritis ( RA ) requires a shared decision‐making ( SDM ) process. However, ability to pay is a major determinant of patient choice, but how this factor affects SDM is under‐explored. Methods Visits at 4 RA clinics during which patients faced a decision to change their treatment were audiotaped between May 2016 and June 2017. Audiotapes were transcribed verbatim and analyzed using qualitative framework analysis. Results A total of 156 visits were analyzed. Most patients with RA , except those with effective insurance coverage, had deliberations disrupted or sidelined by third‐party insurance providers having power to authorize the preferred disease‐modifying antirheumatic drug choice. This triangulated SDM complicated efficiency in deliberations and timely treatment and was a barrier to shared engagement about health risks and symptom improvement typically found in patient‐provider dyads. Conclusion Rheumatology care providers should aim to incorporate treatment costs and ability to pay into their deliberations so that individualized out‐of‐pocket estimates can be considered during triangulated SDM at the point‐of‐care.