Australian quality standard for RA is on its way

4 minute read

ARA members and other stakeholders will soon be surveyed on proposed clinical care standards for adults with rheumatoid arthritis.

The Australian Rheumatology Association, in collaboration with Arthritis Australia, is developing a quality standard for the diagnosis and management of rheumatoid arthritis (RA) in Australia.

ARA members and other health professionals, such as GPs and allied health professionals, and people with RA and their carers will soon be invited to review a number of quality statements and indicate their agreement on each.

The final product will be a consensus-based quality standard aimed at improving care for people with RA. It will also help to inform consumers about what care they should expect to be offered or receive.

The standard development process, led by Professor Catherine Hill, started back in August 2022, and is expected to be completed by the end of this year.

The working group tasked with developing the standard comprises rheumatologists from public and private practice, an advanced trainee, a GP, a rheumatology nurse, allied health professionals involved in the management of RA and a consumer representative.

Rheumatology Republic spoke to Dr Maria Sukkar, the project officer employed by the ARA to assist in the design and implementation of the development process.

Health professionals in Australia aren’t very familiar with quality standards, said Dr Sukkar, and they’re not the same as clinical guidelines.

“Clinical guidelines are evidence-based, they give you best practice recommendations on how to deal with the condition or the disease from A to Z: how to diagnose, what drug you should use and when, what do you do when it doesn’t work and so on,” she said.

“Quality standards – which are informed by clinical guidelines, among other things – comprise a small number of quality statements based around measurable processes and outcomes, designed to drive and measure quality improvements in priority areas within a particular area of care.

“The idea is to pull out those things where we feel that if we targeted that particular thing, we would make a big improvement in outcomes.”

In Australia, there’s a handful of quality standards that sit with the Australian Commission on Safety and Quality in Health Care. Knee osteoarthritis and low back pain are among the musculoskeletal conditions covered, but there are none for autoimmune inflammatory conditions.

“There are quality standards for RA in the UK (NICE), Europe (EULAR) and America (ACR). But there is currently no Australian quality standard by which to assess, improve and monitor the quality of care for people with RA,” said Dr Sukkar.

Monitoring disease activity is one of the priority areas identified for quality improvement.

“One of the draft quality statements is that in adults with active RA, disease activity is assessed every 1 to 3 months until the treatment target is met and then every 6 to 12 months thereafter. If the community agrees with that, that means that’s the standard – and it’s measurable,” said Dr Sukkar.

“So, if someone then went out and measured this in real life practice and found out that three-quarters of the patients are not being assessed every 1 to 3 months when they should be – you can go to the government, and say, look, there’s not enough rheumatologists in this country.”

Consumer input is integral to the standard, said Dr Sukkar, with in-depth consumer workshops and interviews kicking off the process and further consumer involvement in the working group.

“Arthritis Australia did some focus workshops with consumers who have rheumatoid arthritis,” said Dr Sukkar.

“We showed them the existing standards from the UK and Europe, and asked them, ‘What do you think should be included? What do you think of these ones? What’s missing? What do you think we should add based on your experience? What are some priority areas we should target?’”

The resulting report from the consumer sessions included about 30 recommendations. These have been put to the working group to consider, along with existing standards from other countries and clinical guidelines.

From that, the working group has been asked to come up with about ten priority areas which are now being finalised, with the national survey due to take place in mid-June.

ARA members and other stakeholders will be invited to take part in providing consensus on the statements, with the final standard expected to be completed by the end of the year.

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