- Title
- A single centre study evaluating adherence to methotrexate monitoringguidelinesin patients with rheumatoid arthritis
- Creator
- Genevieve, Olivier
- Description
- Introduction: Methotrexate (MTX) is considered a first-line agent for the treatment of rheumatoid arthritis (RA) and regular blood test monitoring is advised in treatment guidelines to identify potential toxicity. Failure to adhere to monitoring guidelines for methotrexate use may compromise patient care. Identifying and correcting variability in care may optimise the safe use of this medication and improve patient outcomes. Aims: This study aimed to evaluate adherence to guidelines on methotrexate safety monitoring in rheumatoid arthritis patients at an Eastern Cape hospital and to establish whether a dedicated rheumatology outpatient department (OPD) performs this task more effectively than a general medical outpatient department (MOPD). Method: This retrospective cross-sectional single-centre study was conducted at Frere Hospital in the Eastern Cape over one year from 1 January 2019 to 31 December 2019. Adult patients over the age of 18 years who received methotrexate for rheumatoid arthritis during the study period and attended either the rheumatology OPD or the MOPD at Frere Hospital were included in the study population. Permission to undertake this study was obtained through the Faculty of Health Sciences Research Ethics and Bio-safety Committee at Walter Sisulu University and the Cecilia Makiwane and Frere Hospitals Research and Ethics Committee. The random sample generator tool on Microsoft Excel was used to select patients from the Frere Hospital Pharmacy Database who was prescribed methotrexate for rheumatoid arthritis. Laboratory test results were accessed through the Labtrak system of the National Health Laboratory Service (NHLS). The number and type of blood test done as recommended in a South African Methotrexate use guideline by Hodkinson et al, was documented on a data collecting sheet. Two or more blood tests done within a three-to six month period was considered adherent to the guideline. The hospital management system version two (HMS2) was used to see which clinic the patient attended. iii Results: There was 53% adherence (95% Confidence Interval 42-65%) overall to guideline. In the study sample, 64% of patients were from Rheumatology OPD and the remainder were from MOPD. There was 78% (95% CI 62-89%) adherence in the Rheumatology OPD compared to 22% (95% CI 11-38%) in MOPD. No significant association was found between the number of FBC tests and the site of testing (p-value = 0.346) or for Creatinine tests (p-value = 0.078). However, a significant association was found with ALT tests and the site of testing (MOPD or rheumatology OPD) with p-value = 0.010, although this is likely a chance finding. Conclusion: Adherence to a South African guideline for methotrexate safety monitoring was found to be suboptimal at the study centre. Adherence was better in the dedicated Rheumatology OPD compared to a general medical OPD. Education regarding the correct use of guidelines in different health settings by medical professionals is advised.
- Description
- Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
- Date
- 2023-00
- Subject
- Medicine
- Type
- Masters theses, text
- Identifier
- http://hdl.handle.net/11260/9690
- Identifier
- vital:74612
- Format
- computer, online resource, application/pdf, 1 online resource (58 pages), pdf
- Publisher
- Walter Sisulu University, Faculty of Medicine and Health Sciences
- Language
- English
- Rights
- Faculty of Medicine and Health Sciences, All Rights Reserved, Open Access
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details | SOURCE1 | Genevieve Olivier.pdf | 1 MB | Adobe Acrobat PDF | View Details |