The TITRATE trial seeks to test whether intensive management is valuable in achieving disease remission in moderately active rheumatoid arthritis. Intensive management is a complex intervention consisting of: 1) 12 x monthly appointments, 2) tailored ‘treatment support’ based on motivational interviewing techniques, 3) optimised medication (including the opportunity for biologics), 4) provision of a Patient Handbook, and 5) shared treatment planning. This study aims to understand: a) patients’ and practitioners’ views on the feasibility and acceptability of intensive management, and b) patients’ and practitioners’ experience of receiving/providing intensive management. A qualitative study, nested within a randomised controlled trial. Participants were patients (n = 15) in the intensive management arm of the trial and rheumatology practitioners (n = 16) providing the intensive management intervention, from 18/42 clinics across England. Data were collected via semi-structured interviews and analysed using thematic analysis and iterative categorization. Monthly appointments were largely acceptable to both groups who cited several treatment benefits (e.g. regular review of medication, practitioners built close relationships with patients). Practitioners were ‘fairly confident’ using the motivational interviewing techniques. Learning to pace was the most commonly reported self-management technique that patients and healthcare professionals worked on together, followed by gaining control over pain and fatigue. Practitioners liked having the option to offer biologics to patients with moderate RA. Most patients found the optimised medication (following monthly joint assessment) helpful and side-effects experienced were resolved. Variation existed in the extent to which patients engaged with the Patient Handbook and shared treatment planning, with those who did engage doing so in the early stages. Feedback from patient participants about the intensive management intervention was positive. They found increased medication helpful. Continuity of care with the same healthcare professional at regular intensive management sessions, and the treatment support provided, were highly rated. Feedback from practitioners indicated that intensive management training is feasible. Evidence from the interviews showed that some practitioners applied motivational interviewing techniques during standard care appointments and they would like the opportunity to address lifestyle issues with patients.

中文翻译：

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中度类风湿关节炎的强化治疗：患者和医生观点的定性研究

TITRATE 试验旨在测试强化治疗对于中度活动性类风湿关节炎的疾病缓解是否有价值。强化管理是一项复杂的干预措施，包括：1) 12 次每月预约，2) 基于动机访谈技术的定制“治疗支持”，3) 优化药物治疗（包括生物制剂的机会），4) 提供患者手册，以及5）共享治疗计划。本研究旨在了解：a) 患者和从业者对强化管理的可行性和可接受性的看法，以及 b) 患者和从业者接受/提供强化管理的经验。一项定性研究，嵌套在随机对照试验中。参与者是来自英格兰 18/42 诊所的强化管理组的患者 (n = 15) 和提供强化管理干预的风湿病从业者 (n = 16)。通过半结构化访谈收集数据，并使用主题分析和迭代分类进行分析。两组患者都基本上可以接受每月预约，他们都提到了一些治疗益处（例如定期审查药物、医生与患者建立了密切的关系）。从业者对使用动机性访谈技巧“相当有信心”。学习节奏是患者和医疗保健专业人员共同努力的最常见的自我管理技术，其次是控制疼痛和疲劳。从业者喜欢为中度 RA 患者提供生物制剂。大多数患者发现优化的药物（每月联合评估后）有帮助，并且所经历的副作用得到解决。患者参与《患者手册》和共享治疗计划的程度存在差异，而那些在早期阶段就参与的患者则不同。患者参与者对强化管理干预的反馈是积极的。他们发现增加药物治疗有帮助。在定期强化管理课程中由同一医疗保健专业人员提供的连续护理以及所提供的治疗支持受到了高度评​​价。从业者的反馈表明，强化管理培训是可行的。访谈证据表明，一些从业者在标准护理预约期间应用了动机访谈技巧，他们希望有机会解决患者的生活方式问题。