The Challenges of Measuring Adherence to Clinical Treatment Recommendations in Spondyloarthritis

Abstract

Clinical treatment recommendations are intended to provide evidence-based guidance to healthcare practitioners about appropriate care for specific clinical situations, with the goal of using that guidance to improve patient care. Unfortunately, translating treatment recommendations from the library literature review to routine clinical care can present a significant challenge. Many groups may propose treatment recommendations for the same disorder, and in some cases these recommendations may be contradictory. Further, the number of treatment recommendations that emerge at a steady pace make it difficult for the clinician to keep up to date. In 2017 so far, the American College of Rheumatology has already published 2, and the European League Against Rheumatism has published 6 sets of treatment recommendations. Despite the frequency of recommendations, it is difficult to assess whether they are being applied routinely to clinical care. In this issue of The Journal , Harvard, et al 1 address this problem by evaluating a system to define adherence to anti-tumor necrosis factor (TNF) use recommendations in spondyloarthritis (SpA). Additionally, they evaluate how adherence to anti-TNF use recommendations in SpA affects economic and health outcomes, while controlling for adherence to other SpA recommendations. Harvard, et al ’s study included 469 patients who met the Assessment of Spondyloarthritis international Society (ASAS) criteria for SpA2 in … Address correspondence to Dr. S. Rohekar. E-mail: sherry.rohekar{at}sjhc.london.on.ca