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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Research article

What factors could influence physicians' management of women of childbearing age with chronic inflammatory disease? A systematic review of behavioural determinants of clinical inertia

Authors: Catherine Nelson-Piercy, Ivo Vlaev, Katie Harris, Rebecca Fischer-Betz

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Pregnancy represents a complex challenge to clinicians treating women with chronic inflammatory disease. Many clinicians face a situation of heightened sensitivity to the potential risks and uncertainties associated with the effect of pharmacological treatment on pregnancy outcomes. This may create an environment vulnerable to clinical inertia, whereby behavioural factors such as cognitive heuristics and biases, and other factors such as attitudes to risk and emotion can contribute. This systematic review was undertaken to assess if clinical inertia has been investigated/identified in this setting and took a behavioural science approach to identify and understand the potential determinants of clinical inertia in this treatment setting.

Methods

A systematic literature search was conducted to identify publications which investigated or described clinical inertia or its determinants (e.g. heuristics, biases etc.). Results were coded for thematic analysis using two inter-related behavioural models: the COM-B model and the Theoretical Domains Framework.

Results

Whilst studies investigating or describing clinical inertia in this treatment setting were not identified, the behavioural analysis revealed a number of barriers to the pharmacological management of women of fertile age affected by chronic inflammatory disease. Factors which may be influencing clinician’s behaviour were identified in all domains of the COM-B model. The primary factors identified were a lack of knowledge of treatment guidelines and fears concerning the safety of medications for mother and fetus. Lack of experience of treating pregnant patients was also identified as a contributing factor to undertreatment.

Conclusion

Using a behavioural approach, it was possible to identify potential factors which may be negatively influencing clinician’s behaviour in this treatment setting, although specific research was limited.
Appendix
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Literature
1.
Kashkooli SB, Andrews JM, Roberts MB, Selinger CP, Leong RW. Inflammatory bowel disease-specific pregnancy knowledge of gastroenterologists against general practitioners and obstetricians. United European Gastroenterol J. 2015;3(5):462–70.CrossRefPubMedPubMedCentral
2.
Brouwer J, Hazes JM, Laven JS, Dolhain RJ. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis. 2015;74(10):1836–41.CrossRefPubMed
3.
Jakobsson GL, Stephansson O, Askling J, Jacobsson LT. Pregnancy outcomes in patients with ankylosing spondylitis: a nationwide register study. Ann Rheum Dis. 2016;75(10):1838–42.CrossRefPubMed
4.
Tauscher AE, Fleischer AB Jr, Phelps KC, Feldman SR. Psoriasis and pregnancy. J Cutan Med Surg. 2002;6(6):561–70.CrossRefPubMed
5.
Zbinden A, van den Brandt S, Ostensen M, Villiger PM, Forger F. Risk for adverse pregnancy outcome in axial spondyloarthritis and rheumatoid arthritis: disease activity matters. Rheumatology (Oxford). 2018.
6.
Strain WD, Bluher M, Paldanius P. Clinical inertia in individualising care for diabetes: is there time to do more in type 2 diabetes? Diabetes Ther. 2014;5(2):347–54.CrossRefPubMedPubMedCentral
7.
Reach G. Clinical inertia, uncertainty and individualized guidelines. Diabetes Metab. 2014;40(4):241–5.CrossRefPubMed
8.
Rodondi N, Peng T, Karter AJ, Bauer DC, Vittinghoff E, Tang S, et al. Therapy modifications in response to poorly controlled hypertension, dyslipidemia, and diabetes mellitus. Ann Intern Med. 2006;144(7):475–84.CrossRefPubMedPubMedCentral
9.
Phillips LS, Branch WT, Cook CB, Doyle JP, El-Kebbi IM, Gallina DL, et al. Clinical inertia. Ann Intern Med. 2001;135(9):825–34.CrossRefPubMed
10.
Khunti K, Davies MJ. Clinical inertia-time to reappraise the terminology? Prim Care Diabetes. 2017;11(2):105–6.CrossRefPubMed
11.
Saposnik G, Sempere AP, Prefasi D, Selchen D, Ruff CC, Maurino J, et al. Decision-making in multiple sclerosis: the role of aversion to ambiguity for therapeutic inertia among neurologists (DIScUTIR MS). Front Neurol. 2017;8:65.PubMedPubMedCentral
12.
Smolen JS, Landewe R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76(6):960–77.CrossRefPubMed
13.
Stoffer MA, Schoels MM, Smolen JS, Aletaha D, Breedveld FC, Burmester G, et al. Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update. Ann Rheum Dis. 2016;75(1):16–22.CrossRefPubMed
14.
van Vollenhoven R. Treat-to-target in rheumatoid arthritis - are we there yet? Nat Rev Rheumatol. 2019;15(3):180–6.CrossRefPubMed
15.
Reach G. Clinical inertia: a critique of medical reason. Springer International Publishing 2015.
16.
Dolan P, Hallswort M, Halpern D, King D, Metcalfe R, & Vlaev I. Influencing behaviour: the mindspace way. J Econ Psychol. 2012;33:264–277.
17.
Blumenthal-Barby JS, Krieger H. Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy. Med Decis Mak. 2015;35(4):539–57.CrossRef
18.
Saposnik G, Redelmeier D, Ruff CC, Tobler PN. Cognitive biases associated with medical decisions: a systematic review. BMC Med Inform Decis Mak. 2016;16(1):138.CrossRefPubMedPubMedCentral
19.
Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.CrossRefPubMedPubMedCentral
20.
Atkins L, Francis J, Islam R, O'Connor D, Patey A, Ivers N, et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77.CrossRefPubMedPubMedCentral
21.
Krause ML, Amin S, Makol A. Use of DMARDs and biologics during pregnancy and lactation in rheumatoid arthritis: what the rheumatologist needs to know. Ther Adv Musculoskelet Dis. 2014;6(5):169–84.CrossRefPubMedPubMedCentral
22.
Keeling SO, Oswald AE. Pregnancy and rheumatic disease: "by the book" or "by the doc". Clin Rheumatol. 2009;28(1):1–9.CrossRefPubMed
23.
Makol A, Wright K, Amin S. Rheumatoid arthritis and pregnancy: safety considerations in pharmacological management. Drugs. 2011;71(15):1973–87.CrossRefPubMed
24.
Meade T, Sharpe L, Hallab L, Aspanell D, Manolios N. Navigating motherhood choices in the context of rheumatoid arthritis: women's stories. Musculoskeletal Care. 2013;11(2):73–82.CrossRefPubMed
25.
Ng SW, Mahadevan U. My treatment approach to management of the pregnant patient with inflammatory bowel disease. Mayo Clin Proc. 2014;89(3):355–60.CrossRefPubMed
26.
Ng SW, Mahadevan U. Management of inflammatory bowel disease in pregnancy. Expert Rev Clin Immunol. 2013;9(2):161–73 quiz 74.CrossRefPubMed
27.
Barbhaiya M, Bermas BL. Evaluation and management of systemic lupus erythematosus and rheumatoid arthritis during pregnancy. Clin Immunol. 2013;149(2):225–35.CrossRefPubMed
28.
Rhodes R, Smith Z, Adams J, Stoner J, Ali T. Assessment of Physicians' perceived risk of inflammatory bowel disease medications in pregnant patients. Gastroenterol Hepatol (N Y). 2014;10(12):803–8.
29.
Saavedra Salinas MA, Barrera Cruz A, Cabral Castaneda AR, Jara Quezada LJ, Arce-Salinas CA, Alvarez Nemegyei J, et al. Clinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part II. Reumatol Clin. 2015;11(5):305–15.
30.
Chakravarty EF, Sanchez-Yamamoto D, Bush TM. The use of disease modifying antirheumatic drugs in women with rheumatoid arthritis of childbearing age: a survey of practice patterns and pregnancy outcomes. J Rheumatol. 2003;30(2):241–6.PubMed
31.
Peyrin-Biroulet L, Oussalah A, Roblin X, Sparrow MP. The use of azathioprine in Crohn's disease during pregnancy and in the post-operative setting: a worldwide survey of experts. Aliment Pharmacol Ther. 2011;33(6):707–13.CrossRefPubMed
32.
Biedermann L, Rogler G, Vavricka SR, Seibold F, Seirafi M. Pregnancy and breastfeeding in inflammatory bowel disease. Digestion. 2012;86(Suppl 1):45–54.CrossRefPubMed
33.
Ackerman IN, Jordan JE, Van Doornum S, Ricardo M, Briggs AM. Understanding the information needs of women with rheumatoid arthritis concerning pregnancy, post-natal care and early parenting: a mixed-methods study. BMC Musculoskelet Disord. 2015;16:194.CrossRefPubMedPubMedCentral
34.
35.
Ortleb M, Levitt JO. Practical use of biologic therapy in dermatology: some considerations and checklists. Dermatol Online J. 2012;18(2):2.PubMed
36.
Beaulieu DB, Kane S. Inflammatory bowel disease in pregnancy. Gastroenterol Clin N Am. 2011;40(2):399–413 ix.CrossRef
37.
38.
Borchers AT, Naguwa SM, Keen CL, Gershwin ME. The implications of autoimmunity and pregnancy. J Autoimmun. 2010;34(3):J287–99.CrossRefPubMed
39.
Danion P, Buisson A, Roblin X, Mathieu N, Charlois AL, Borgerding JN, et al. IBD-INFO questionnaire: a multicenter French up-to-date survey of patient knowledge in inflammatory bowel disease. Inflamm Bowel Dis. 2018;24(5):943–52.CrossRefPubMed
40.
Gupta R, High WA, Butler D, Murase JE. Medicolegal aspects of prescribing dermatological medications in pregnancy. Semin Cutan Med Surg. 2013;32(4):209–16.CrossRefPubMed
41.
Habal FM, Huang VW. Review article: a decision-making algorithm for the management of pregnancy in the inflammatory bowel disease patient. Aliment Pharmacol Ther. 2012;35(5):501–15.CrossRefPubMed
42.
Mahadevan U, Matro R. Care of the Pregnant Patient with Inflammatory Bowel Disease. Obstet Gynecol. 2015;126(2):401–12.CrossRefPubMed
43.
44.
Mottet C, Vader JP, Felley C, Froehlich F, Gonvers JJ, Juillerat P, et al. Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): results of a multidisciplinary international expert panel-EPACT II. J Crohns Colitis. 2009;3(4):257–63.CrossRefPubMed
45.
Ostensen M. Contraception and pregnancy counselling in rheumatoid arthritis. Curr Opin Rheumatol. 2014;26(3):302–7.CrossRefPubMed
46.
Ostensen M. Preconception counseling. Rheum Dis Clin N Am. 2017;43(2):189–99.CrossRef
47.
Thompson AE, Bashook PG. Rheumatologists' recommended patient information when prescribing methotrexate for rheumatoid arthritis. Clin Exp Rheumatol. 2010;28(4):539–45.PubMed
48.
Vader JP, Froehlich F, Juillerat P, Burnand B, Felley C, Gonvers JJ, et al. Appropriate treatment for Crohn's disease: methodology and summary results of a multidisciplinary international expert panel approach–EPACT. Digestion. 2006;73(4):237–48.
49.
van der Woude CJ, Ardizzone S, Bengtson MB, Fiorino G, Fraser G, Katsanos K, et al. The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis. 2015;9(2):107–24.CrossRefPubMed
50.
51.
52.
53.
Wallenius M, Salvesen KA, Daltveit AK, Skomsvoll JF. Miscarriage and stillbirth in women with rheumatoid arthritis. J Rheumatol. 2015;42(9):1570–2.CrossRefPubMed
54.
Bharti B, Lee SJ, Lindsay SP, Wingard DL, Jones KL, Lemus H, et al. Disease severity and pregnancy outcomes in women with rheumatoid arthritis: results from the Organization of Teratology Information Specialists Autoimmune Diseases in pregnancy project. J Rheumatol. 2015;42(8):1376–82.CrossRefPubMed
55.
Gotestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016;75(5):795–810.CrossRefPubMed
56.
Iacobucci G. MHRA bans valproate prescribing for women not in pregnancy prevention programme. BMJ. 2018;361:k1823.CrossRefPubMed
57.
Skuladottir H, Wilcox AJ, Ma C, Lammer EJ, Rasmussen SA, Werler MM, et al. Corticosteroid use and risk of orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014;100(6):499–506.CrossRefPubMedPubMedCentral
58.
59.
Baatiema L, Otim ME, Mnatzaganian G, de-Graft Aikins A, Coombes J, Somerset S. Health professionals' views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review. Implement Sci. 2017;12(1):74.CrossRefPubMedPubMedCentral
60.
Kerr EA, Zikmund-Fisher BJ, Klamerus ML, Subramanian U, Hogan MM, Hofer TP. The role of clinical uncertainty in treatment decisions for diabetic patients with uncontrolled blood pressure. Ann Intern Med. 2008;148(10):717–27.CrossRefPubMed
61.
Lavoie KL, Rash JA, Campbell TS. Changing provider behavior in the context of chronic disease management: focus on clinical inertia. Annu Rev Pharmacol Toxicol. 2017;57:263–83.CrossRefPubMed
Metadata
Title
What factors could influence physicians' management of women of childbearing age with chronic inflammatory disease? A systematic review of behavioural determinants of clinical inertia
Authors
Catherine Nelson-Piercy
Ivo Vlaev
Katie Harris
Rebecca Fischer-Betz
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4693-x

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