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Facilitating the use of COBRA combination therapy in early rheumatoid arthritis: A pilot implementation study
Journal of Rheumatology, 07/02/09

van Tuyl LHD et al. – Study reports that rheumatologists, patients, and arthritis nurses all highly appreciated the implementation package of COBRA in Dutch clinical practice and also indicated that its availability would increase uptake of COBRA therapy.

Methods

Combinatietherapie Bij Reumatoide Artritis (COBRA) therapy is a step-down combination therapy with prednisolone, methotrexate (MTX), and sulfasalazine (SSZ)
A pilot testing of an implementation package to facilitate prescription and use of COBRA therapy in Dutch population with early RA is described
This was developed to address specific barriers towards prescription of COBRA therapy and comprised of:
- Informational handouts (an information booklet and leaflet for pts)
- Preprinted prescription orders, and
- Background information on COBRA therapy for rheumatologists
22 rheumatologists participated, including the arthritis nurse where available
They were asked to record their experience

Results

16 rheumatologists and 10 arthritis nurses prescribed COBRA therapy to 27 pts
88% of rheumatologists reported that the material sped up the prescription process
65% indicated they would prescribe COBRA therapy more frequently if these materials were available routinely
Pts expressed great satisfaction with the information handouts
89% pts planned to keep the information booklet as a reference; 70% used it as a tool to remember the correct intake of medication
Attitude and perceived capability of nurses towards the guidance of pts receiving COBRA therapy was improved through a brief educational intervention

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