European Journal of Rheumatology
Original Article

Identifying physician-perceived barriers to a pragmatic treatment trial in rheumatoid arthritis


School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA


Research, Development, & Analytics, Gateway Health, Pittsburgh, PA, USA


Medicine Service, Birmingham veterans Affairs (VA) Medical Center, Birmingham, AL, USA


Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA


Division of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA


Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA

Eur J Rheumatol 2022; 9: 132-138
DOI: 10.5152/eujrheum.2022.21038
Read: 1462 Downloads: 489 Published: 24 January 2022

Objective: The aim of this qualitative research was to identify physician-perceived patient and clinic barriers to patient recruitment in a rheumatoid arthritis (RA) pragmatic trial of anti-tumor necrosis factor (TNF) biologic versus non-TNF biologic/Janus-Kinase inhibitor initiation after an inadequate response to methotrexate.

Methods: Semistructured telephone interviews were conducted with 26 rheumatologists in March 2019. An exploratory thematic analysis approach was used to analyze the interview data.

Results: Physician perceived patient barriers to the implementation of an RA pragmatic trial. This theme covers three subthemes: (1) patients’ personal barriers, (2) patients’ treatment-related factors, and (3) trial-related factors (eg, patient recruitment, side effects, mode of use, etc). Physicians perceived clinic barriers interfered with the pragmatic trial enrollment from the clinic or the healthcare system perspective. This theme covered four subthemes: (1) clinic-related factors, (2) patient-related factors, (3) research personnel, and (4) facilitators (positive factors of the clinic).

Conclusion: Our results from the inductive thematic analysis will help researchers understand the key patient and clinic/system factors/barriers that may influence pragmatic RA trial implementation. The themes suggest there are factors that can be modified (eg, coordinator effort needed, effective patient recruitment during clinic visits, provider engagement) and challenges to overcome (patient insurance status, busy clinic flow, and space issues including limited number of patient rooms). In summary, these themes provide a basis for our and other research teams to develop clinic-centered and patientcentered strategies to implement a pragmatic RA trial.

Cite this article as: Qu H, Austin S, Singh JA. Identifying physician-perceived barriers to a pragmatic treatment trial in rheumatoid arthritis. Eur J Rheumatol. 2022;9(3):132-138.

EISSN 2148-4279