Clinical Practice Guidelines, Newly Diagnosed Adults, and Health Literacy

Clinical practice guidelines, according to Fraenkel et al. (2016), are an invaluable tool for improving patient outcomes, for they are grounded in evidence-based practice. However, as is often the case, physicians and patients may value different things. For instance, adults newly diagnosed with active rheumatoid arthritis might go into shock or denial about the diagnostic results. On the other hand, the physicians would be prioritizing on getting the patient to immediately start their drug therapy to help fight erosions and joint damage. 

Therefore, there is a communication breakdown between the patient and the physician. There are two general treatment therapies for rheumatoid arthritis; biological agents and disease-modifying antirheumatic drugs. To the patient, however, health literacy prevents them from differentiating one drug therapy from another, and it is rare to find resources that explain the differences with the adequate level of detail, be comprehensive, and using language that any adult walking in from the street would understand. 

Alternatively, an evidence-based study on the effectiveness of one relative to the other could help the physicians recommend the appropriate drug therapy. To avoid bias, especially since biologic agents have only been recently developed, clinical practice guidelines, such as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), used by the American College of Rheumatology (ACR) could be used. Below is the PICOT question that would guide the evidence-based research. 

PICOT Question 

Among adults ages 30 – 60 newly diagnosed with active rheumatoid arthritis ( P ), what is the effectiveness of biologic agents ( I ) as compared to non-biologic disease-modifying antirheumatic drugs ( C ) in preventing or slowing down erosions ( O ) over 3 - 5years ( T ). 

P = Population of patients: Among adults ages 30 – 60 newly diagnosed with active rheumatoid arthritis 

I = Intervention: The effectiveness of biologic agents 

C = Comparison: Non-biologic disease-modifying antirheumatic drugs 

O = Outcome: preventing or slowing down erosions 

T = Timeframe: 3 - 5years 

References 

Fraenkel, L., Miller, A. S., Clayton, K., Crow‐Hercher, R., Hazel, S., Johnson, B., ... & Singh, J. A. (2016). When patients write the guidelines: patient panel recommendations for the treatment of rheumatoid arthritis.  Arthritis care & research ,  68 (1), 26-35.