DMP “rheumatoid arthritis”: guidelines cover important health care aspects

On 28 April 2016 the German Institute for Quality and Efficiency in Health Care (IQWiG) published the results of a search for evidence-based guidelines on the treatment of people with rheumatoid arthritis. The aim of the report is to identify those recommendations from current guidelines of high methodological quality that may be relevant for a potential new disease management programme (DMP) “rheumatoid arthritis”. According to the results of the report the recommendations cover nearly all important health care aspects; however, rehabilitation measures are only addressed sporadically. The focus of the recommendations is on drug therapy.

Only few guidelines address several health care aspects

IQWiG included a total of 18 guidelines in its analysis; however, only 2 of them originated from Germany. The focus of the guidelines identified is drug therapy, in particular, treatment with disease-modifying antirheumatic drugs (DMARDs). Only 4 guidelines, including one from Germany, address several health care aspects such as diagnostics, non-drug therapies and cross-sector health care.

The aspect of rehabilitation is only addressed sporadically in the guidelines and in little detail. The following topics are mentioned: non-drug treatment procedures such as physiotherapy and ergotherapy for functional limitations, ortheses for pain alleviation or diet change for promotion of the general state of health. However, for these topics the guidelines include only sporadic strong recommendations that are relevant for a potential DMP.

International guidelines only applicable to a limited extent

If guidelines were developed in other countries, in each case it always has to be evaluated whether their recommendations are also applicable to the German health care context. This especially applies to recommendations on the aspect of nursing care. Nurses undertake, among other things, tasks in the training of patients and in hospital management. However, in other countries nurses have specific academic qualifications as well as greater responsibilities than in Germany. For example, 6 of the guidelines considered originate from the United Kingdom, where patients are cared for by “clinical nurse specialists”.

Procedure of report production

IQWiG published the preliminary results in the form of the preliminary report in October 2015 and interested parties were invited to submit comments. When the commenting procedure ended, the preliminary report was revised and sent as a final report to the commissioning agency, the Federal Joint Committee, in March 2016. The written comments submitted are published in a separate document at the same time as the final report. The report was produced in collaboration with external experts.