Consensus development on requirements in methotrexate prescribing, monitoring and patient’s self-care in the treatment of rheumatoid arthritis

The aim of the study was to identify potential problems and concerns of rheumatology specialists regarding methotrexate therapy and to obtain recommendations about good practice standards for methotrexate use in the treatment of rheumatoid arthritis. Four rounds of the Delphi technique were used for a consensus development among 38 rheumatology specialists in Scotland. The participants were asked to indicate their opinion for 42 questions in a total questionnaire using a 9-point Likert scale (1: Strongly disagree to 9: Strongly agree). The results of each round were analyzed and presented in numbers and percentages of participants answering for each questions and group median (interquartile range) scores. The survey revealed that there were variations in the practice of rheumatology specialists in the use of methotrexate therapy. The participants were practicing in a similar way in terms of methotrexate initial dose and dose increments, monitoring parameters; however they were not willing to delegate monitoring issues to other health care professionals, except nurse specialist. On the other hand, the rheumatologists supported the idea of delegation some of the monitoring issues regarding methotrexate side effects to the patients. Differences in preferences among rheumatology specialists on the criteria for monitoring patients receiving methotrexate treatment and the variability in local guidelines has led to different practices in the provision of care. Recognition of roles and delegation of certain responsibilities to the other health providers (such as general practitioners and pharmacists) in a multidisciplinary shared care would yield to safe and effective drug use, close monitoring, and continuity of care.