Berlin. The Institute for Quality and Efficiency in Healthcare (IQWiG) confirms that the DMP for Rheumatoid Arthritis (RA) needs to be updated. The areas where the institute has identified discrepancies with the guidelines’ recommendations include, among other things, follow-up monitoring and the psychological and psychosocial care of patients.
The DMP requirements guidelines do not yet contain specifics on this point. However, the guidelines recommend that structured psychoeducational interventions be provided to patients in the case of inflammatory rheumatic diseases, for example. These could be disease and stress management programs, and the use of behavioral therapy or mind-body approaches is also suggested.
Reference to self-management programs
In its report on the preliminary results of the evaluation, IQWiG highlights that the interactive training programme “StruPI-RA” has proven to be an effective, everyday intervention to improve self-management. The programme could improve therapy safety, therapy adherence, patient knowledge and thus treatment success.
Along with the extended “StruPS” training programme, rheumatoid arthritis patients have two assessed and coordinated programmes at their disposal, “which can be implemented in outpatient and inpatient settings, as well as in the rehabilitation area”, he says.
Addressing smoking cessation?
When dealing with comorbidities, IQWiG refers to the guideline recommendations that concern prophylactic antiviral therapy: on the one hand, for patients who are HBc antibody positive (regardless of HBsAg status) and are being treated with rituximab, and on the other hand, for patients who are both HBc and HBsAg antibody positive and are being treated with bDMARDs or tsDMARDs.
The topics of nutrition and smoking are also considered worthy of consideration. The EULAR 2023 lifestyle guideline, for example, makes two recommendations on smoking cessation and informing patients about the consequences of tobacco use.
IQWiG was commissioned by the Federal Joint Committee in December 2023 to examine the need to update the DMP RA. To this end, the institute identified current evidence-based guidelines for the treatment of rheumatoid arthritis in order to compare their recommendations with the Disease Management Program Requirements Guidelines and identify any discrepancies. For the now published preliminary report, IQWiG evaluated a total of 239 recommendations from 13 guidelines. (yuck)