Barriers to, Facilitators of, and Interventions to Support Treat‐to‐Target Implementation in Rheumatoid Arthritis: A Systematic Review

Objective Treat‐to‐target is recommended in the management of rheumatoid arthritis (RA) but its implementation is suboptimal. We aimed to identify interventional strategies targeted at improving treat‐to‐target implementation in RA by systematically reviewing published evidence on barriers to, facilitators of, and interventions to support treat‐to‐target implementation. Methods Systematic and scoping literature searches in PubMed/MEDLINE, BIOSIS Previews, Derwent Drug File, Embase, EMCare, International Pharmaceutical Abstracts, and SciSearch were conducted to identify barriers/facilitators and interventions relating to treat‐to‐target implementation in RA. The quality of included studies was assessed using Critical Appraisal Skills Programme (CASP) checklists. Data related to barriers/facilitators and interventions were extracted, grouped, and summarized descriptively, and a narrative synthesis was generated. Results In total, 146 articles were analyzed, of which 123 (84%) included ≥50% of the items assessed by CASP checklists. Of the 146 studies, 76 evaluated treat‐to‐target barriers and facilitators, from which 329 relevant statements were identified and regrouped into 18 target areas, including health care professional (HCP) or patient knowledge or perceptions; patient‐HCP communication or alignment; and time or resources. Overall, 56 interventions were identified from 70 studies across the 18 target areas; 54% addressed disease activity or patient‐reported outcome assessments. Of the 56 interventions identified, 36 improved treat‐to‐target implementation and/or patient outcomes in RA. Conclusion Despite long‐established treat‐to‐target recommendations, there remain many barriers to its implementation. Interventions to improve treat‐to‐target should be developed further and assessed, with a particular focus on tailoring them to individual countries, regions, and health care settings.