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Local adaptation of recommendation-based materials for shared decision-making and management of comorbidity in rheumatoid arthritis

1, 2, 3, 4, 5, 6, 7, 8, 9


  1. Rheumatology Department, University General Hospital Gregorio Marañón, Madrid, Spain.
  2. Rheumatology Department, Complexo Hospitalario Universitario de Vigo, Spain.
  3. Rheumatology Department, Hospital of Galdakao Usansolo, Vizcaya, Spain.
  4. Rheumatology Department, University Hospital Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, Madrid, Spain.
  5. Rheumatology Department, University Hospital Parc Taulí, Sabadell, Spain.
  6. Rheumatology Department, Hospital Can Misses, Ibiza, Spain.
  7. Rheumatology Department, University Hospital Reina Sofía, Córdoba, Spain.
  8. Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain.
  9. Rheumatology Department, University Hospital Araba, Vitoria-Gasteiz, Spain.

2022 Vol.40, N°5
PI 0975, PF 0979
Full Papers

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PMID: 34251302 [PubMed]

Received: 05/02/2021
Accepted : 03/05/2021
In Press: 26/06/2021
Published: 13/05/2022


To describe local adaptations of materials derived from evidence-based recommendations in a training programme in rheumatoid arthritis (RA).
The eRA (evolving the management of rheumatoid arthritis) programme generated shared decision-making practises and a checklist for managing comorbidity in RA, among others, at the international level. Unmet needs in RA management were first identified and prioritised. Then educational materials were designed and developed to address these gaps. These materials were evaluated in detailed and discussed in small regional groups by practicing rheumatologists. Voting, open discussions and recommendations were extracted from the meetings.
Thirty-five Spanish rheumatologists discussed a comorbidity checklist and a shared decision-making tool. The results of the local meetings were synthesised as (1) a judicious commitment to check agreed comorbidities, and (2) a list of barriers and facilitators for the implementation of shared decision making in the local settings. With regards to ways to implement the agreed list and periodicity, two issues stand-out: (1) patient education and (2) the need of easy access to information and the use of local organisational systems in place. With respect to shared decision-making, issues raised included messages for self-awareness, challenges, and practical facilitators.
Discussion, adaptation, and planning are needed before implementing any evidence-based recommendation and materials if we want to achieve a successful implementation. Further studies should demonstrate whether this initiative was successful in achieving the goals of improved patient care. Our experience could be used as a guidance or example for implementation elsewhere.


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