The provision of pharmaceutical care in a system for the use of methotrexate in the treatment of patients with rheumatoid arthritis
Background: Rheumatoid arthritis (RA) is a chronic, long-term disease, which requires close monitoring by primary and secondary health care providers. However, the involvement of community pharmacist in the disease management process has not been previously identified in literature. Aim: The research aimed to provide a system for a provision of pharmaceutical care for the patients with rheumatoid arthritis with respect to methotrexate (MTX) therapy. Methods: The exploration of the issues around the management of RA was undertaken by using qualitative interviews. The patterns of methotrexate and other disease-modifying antirheumatic drugs (DMARDs) use were identified by retrospective reviews of databases and clinical documents. The Delphi technique was used in order to achieve a consensus among specialists on the prescribing and monitoring of methotrexate and patient self-management strategies. Results: The qualitative interviews highlighted the shortcomings in the communication pat hway between healthcare professionals and emphasised the lack of pharmacists' involvement in the disease management process for the patient with RA. The effectiveness of methotrexate therapy was confirmed by the higher continuation rate compared to the other DMARDs, where socio-economic environment of patients did not show any effect on the treatment discontinuation. The results of the Delphi survey revealed there are variations in the practice of rheumatology specialists in the use of methotrexate therapy. Recommendations for patient self-management activities during methotrexate therapy were suggested through the Delphi. In the practice of methotrexate prescribing and dispensing process, criteria for quality assessment of the methotrexate prescriptions were suggested. Finally, a new model of care to integrate the community pharmacist's contribution to the management of RA with MTX was designed and tested. Conclusion: The findings from this thesis contribute to the understanding of pharmaceutical care provision in patients with RA. The implications of the research on further development of pharmaceutical care services in this arena are discussed.