Patient and health professional views on risk-stratified monitoring of immune-suppressing treatment in adults with inflammatory diseases

Fuller, Amy; Hancox, Jennie; Williams, Hywel C; Card, Tim; Taal, Maarten W; Aithal, Guruprasad P; Fox, Christopher P; Mallen, Christian D; Maxwell, James R; Bingham, Sarah; Vedhara, Kavita; Abhishek, Abhishek

Abstract

To explore the acceptability of an individualised risk-stratified approach to monitoring for target-organ toxicity in adult patients with immune-mediated inflammatory diseases established on immune-suppressing treatment(s). Adults (≥18 years) taking immune-suppressing treatment(s) for at-least six months, and healthcare professionals (HCPs) with experience of either prescribing and/or monitoring immune-suppressing drugs were invited to participate in a single, remote, one-to-one, semi-structured interview. Interviews were conducted by a trained qualitative researcher and explored their views and experiences of current monitoring and acceptability of a proposed risk-stratified monitoring plan. Interviews were transcribed verbatim and inductively analysed using thematic analysis in NVivo. Eighteen patients and 13 HCPs were interviewed. While participants found monitoring of immune-suppressing drugs with frequent blood-tests reassuring, the current frequency of these was considered burdensome by patients and HCPs alike, and to be a superfluous use of healthcare resources. Given abnormalities rarely arose during long-term treatment, most felt that monitoring blood-tests were not needed as often. Patients and HCPs found it acceptable to increase the interval between monitoring blood-tests from three-monthly to six-monthly or annually depending on the patients' risk profiles. Conditions of accepting such a change included: allowing for clinician and patient autonomy in determining an individuals' frequency of monitoring blood-tests, the flexibility to change monitoring frequency if someone's risk profile changed, and endorsement from specialist societies and healthcare providers such as the National Health Service. A risk-stratified approach to monitoring was acceptable to patients and HCPs. Guideline groups should consider these findings when recommending blood-test monitoring intervals. [Abstract copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.]

Citation

Fuller, A., Hancox, J., Williams, H. C., Card, T., Taal, M. W., Aithal, G. P., Fox, C. P., Mallen, C. D., Maxwell, J. R., Bingham, S., Vedhara, K., & Abhishek, A. (2024). Patient and health professional views on risk-stratified monitoring of immune-suppressing treatment in adults with inflammatory diseases. Rheumatology, Article keae175. https://doi.org/10.1093/rheumatology/keae175

• Journal Article Type: Article
• Acceptance Date: Mar 12, 2024
• Online Publication Date: Mar 14, 2024
• Publication Date: Mar 14, 2024
• Deposit Date: Apr 9, 2024
• Journal: Rheumatology (Oxford, England)
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Article Number: keae175
• DOI: https://doi.org/10.1093/rheumatology/keae175
• Keywords: Immune mediated inflammatory disease, qualitative, steroid sparing drugs, blood monitoring
• Public URL: https://keele-repository.worktribe.com/output/786840