Medicines

bDMARD prescribing letters sent to rheumatologists strictly educational, says ARA


Professor Catherine Hill

A new campaign targeting rheumatologists over their bDMARD prescribing is purely educational and won’t form part of any regulatory crackdown, the president of the Australian Rheumatology Association says.

Together with NPS MedicineWise, the ARA last week sent practice review letters to around 450 rheumatologists, analysing their prescribing of bDMARDS and other medicines such as glucucorticoids and opioids.

Running across eight pages, each review featured an individualised comparison of the recipient’s prescribing with the national average across 2019, 2020 and 2021.

Bullet points on recent changes to guidelines were also included, plus 10 short sections for the doctor to fill out themselves and reflect on their practice.

Questions included: “How does the rate of glucocorticoid use in your patients compare with the practice of your peers?”

“Is the rate of glucocorticoid use in your patients in keeping with current practice guideline recommendations? What steps will you take to reduce long-term glucocorticoid use in your patients?”

The campaign followed some controversy over a similar mailout 18 months ago which was branded “Big Brotherish” by Dr Mona Marabani, a Sydney-based rheumatologist and former president of the ARA.

“There is a level of disquiet as to why rheumatologists are being targeted in this way,” she said back in 2020 after the first letters were sent out.

“I think this program is all about saving money, not about quality use of medicines.”

But the association’s current president Professor Catherine Hill has defended the initiative.

She stressed each review was strictly confidential and that recipients were under no obligation to reply or do anything with the information received.

“It’s not big brother,” Professor Hill said.

“This is an educational tool with a lot of information in there beyond just the numbers.”

Head of rheumatology at the Queen Elizabeth Hospital in Adelaide, she said she personally had changed her practice as a result of the previous letter.

“I’ve actually found it really helpful,” she said,

“For example, last time I learned about 50% of my patients were actually taking opioids, but I had only prescribed 3%.”

“It prompted me to start asking patients a lot more about how much opioid they had been taking and I also started giving more feedback to their GPs about opioid use.”

Broader feedback had also been positive, she added.

“The bigger issue we had last time was that quite a few people didn’t realise what was in the letters so they just tossed them.”

“This time we contacted members ahead of time and gave them the opportunity to opt out and nobody said they didn’t want to get it.”

Questions for rheumatologists in the practice review letters:

  • After reviewing the evidence and your practice, how likely are you to titrate the MTX dose up to 20mg/week within six weeks of initiation?
  • How likely are you to use strategies to improve MTX tolerance before moving to a different therapy?
  • How likely are you to prescribe subcutaneous MTX before initiating a b/tsDMARD?
  • Is your practice in line with current guideline recommendations? If not, what steps could you take?
  • After considering the evidence, how likely are you to prescribe biosimilars?
  • How does this compare with the practice of your peers?
  • How does the rate of glucocorticoid use in your patients compare with the practice of your peers?
  • Is the rate of glucocorticoid use in your patients in keeping with current practice guideline recommendations? What steps will you take to reduce long-term glucocorticoid use in your patients?
  • How does the rate of opioid use in your patients compare with the practice of your peers?
  • Is the rate of opioid use in your patients in keeping with current guideline recommendations? What steps will you take to reduce opioid use in your patients?

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