TY - JOUR
T1 - Steps towards implementation of protocolized dose reduction of adalimumab, etanercept and ustekinumab for psoriasis in daily practice
AU - van der Schoot, L. S.
AU - Janssen, J. J.
AU - Bastiaens, M. T.
AU - de Boer-Brand, A.
AU - Christiaansen-Smit, C.
AU - Enomoto, D. N. H.
AU - Hovingh, R.
AU - Tupker, R. A.
AU - Seyger, M. M. B.
AU - Verhoef, L. M.
AU - van den Reek, J. M. P. A.
AU - de Jong, E. M. G. J.
N1 - Funding Information: ZonMw, the Hague, The Netherlands (8360410031). The authors would like to thank all participating healthcare providers. They also want to acknowledge the collaboration with patient representatives from the Dutch psoriasis patients’ association (Psoriasispatiënten Nederland) and with the Dutch Association for Dermatology and Venereology in the overarching project team involved in different projects on implementation of biological dose reduction in the Netherlands. Publisher Copyright: © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.
PY - 2023
Y1 - 2023
N2 - Background: Dose reduction (DR) of adalimumab, etanercept and ustekinumab has proven to be (cost-)effective in psoriasis patients with low disease activity. Further implementation is needed to establish application of DR for eligible patients. Objectives: To evaluate the implementation of protocolized biologic DR in daily practice. Methods: A pilot implementation study was performed in 3 hospitals during 6 months. By combining education and protocol development, involved healthcare providers (HCPs) were directed toward the adoption of protocolized DR. DR of adalimumab, etanercept, and ustekinumab was achieved by stepwise injection interval prolongation. Implementation outcomes (fidelity, feasibility) were assessed. Factors for optimizing implementation were explored in interviews with HCPs. Uptake was measured in patients by chart review. Results: The implementation strategy was executed as planned. Implementation fidelity was less than 100% as not all provided tools were used across study sites. HCPs indicated the feasibility of implementing protocolized DR, although time investment was needed. Identified additional factors for successful implementation included support for patients, uptake of DR into guidelines, and supportive electronic health record systems. During the 6 months intervention period, 52 patients were eligible for DR of whom 26 (50%) started DR. The proposed DR protocol was followed in 22/26 patients (85%) on DR. Conclusion: Additional staff for support, extra time during consultations, education on DR for HCPs and patients, and effective tools such as a feasible protocol can lead to more patients on biologic DR.
AB - Background: Dose reduction (DR) of adalimumab, etanercept and ustekinumab has proven to be (cost-)effective in psoriasis patients with low disease activity. Further implementation is needed to establish application of DR for eligible patients. Objectives: To evaluate the implementation of protocolized biologic DR in daily practice. Methods: A pilot implementation study was performed in 3 hospitals during 6 months. By combining education and protocol development, involved healthcare providers (HCPs) were directed toward the adoption of protocolized DR. DR of adalimumab, etanercept, and ustekinumab was achieved by stepwise injection interval prolongation. Implementation outcomes (fidelity, feasibility) were assessed. Factors for optimizing implementation were explored in interviews with HCPs. Uptake was measured in patients by chart review. Results: The implementation strategy was executed as planned. Implementation fidelity was less than 100% as not all provided tools were used across study sites. HCPs indicated the feasibility of implementing protocolized DR, although time investment was needed. Identified additional factors for successful implementation included support for patients, uptake of DR into guidelines, and supportive electronic health record systems. During the 6 months intervention period, 52 patients were eligible for DR of whom 26 (50%) started DR. The proposed DR protocol was followed in 22/26 patients (85%) on DR. Conclusion: Additional staff for support, extra time during consultations, education on DR for HCPs and patients, and effective tools such as a feasible protocol can lead to more patients on biologic DR.
KW - Psoriasis
KW - biologics
KW - dose reduction
KW - implementation
UR - http://www.scopus.com/inward/record.url?scp=85150079735&partnerID=8YFLogxK
U2 - https://doi.org/10.1080/09546634.2023.2186728
DO - https://doi.org/10.1080/09546634.2023.2186728
M3 - Article
C2 - 36867069
SN - 0954-6634
VL - 34
JO - Journal of Dermatological Treatment
JF - Journal of Dermatological Treatment
IS - 1
M1 - 2186728
ER -