Open Access Highly Accessed Research article

Patient’s access to healthcare and treatment in rheumatoid arthritis: the views of stakeholders in Portugal

Pedro A Laires1*, Rui Mesquita2, Luís Veloso3, Ana Paula Martins1, Rui Cernadas4 and João Eurico Fonseca5

Author Affiliations

1 Merck Sharp & Dohme, Outcomes Research, Quinta da Fonte, Edificio Vasco da Gama, nº19, Paço de Arcos 2770-192, Portugal

2 Merck Sharp & Dohme, Medical Affairs, Oeiras, Portugal

3 Eurotrials, Consultores Científicos, Lisbon, Portugal

4 Administração Regional de Saúde (ARS) Norte, Oporto, Portugal

5 Lisbon Academic Medical Centre, Lisbon, Portugal

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BMC Musculoskeletal Disorders 2013, 14:279  doi:10.1186/1471-2474-14-279

Published: 25 September 2013



The access to healthcare and treatment by rheumatoid arthritis (RA) patients, particularly to biologics, differs significantly among European countries.

We aimed to explore the views and experiences of Portuguese healthcare stakeholders on key barriers which limit the access to treatment, and ultimately to biologics, by RA patients and to find potential solutions (leverage points) to overcome the identified barriers.


This was a qualitative research consisting of semi-structured face-to-face interviews with key stakeholders in RA framework. Thirty four individuals from eight groups of stakeholders were interviewed: rural and urban general practitioners (GPs), rheumatologists, hospital managers, hospital pharmacists, budget holders, representatives from the Portuguese Rheumatology Society and the RA Patient Association. Interviews were conducted between May and June 2011. Conventional content analysis with research triangulation was used.


The key barriers identified were related to the accessibility to primary healthcare services, difficulties in RA diagnosis among GPs, inefficient referral to secondary healthcare and controlled process of biologics prescription in public hospitals. The leverage points identified included the improvement of epidemiological and clinical knowledge about RA in Portugal, a better understanding of the disease among patients and GPs, the clarification of biologics benefits among budget holders and a raised awareness of the current treatment guidelines. In order to further address the leverage points, the following key initiatives were proposed: optimization of RA national registry; dissemination of information on rheumatic symptoms in primary care facilities and among the general public; increase interaction between rheumatologists and GPs through clinical discussions of successfully treated patients or workshops; broader utilization of disease diagnosis and monitoring tools, such as DAS28, and implementation of hospital–based research to collect real-world data.


Most of the key barriers limiting the access to treatment, including biologics, in RA in Portugal are upstream of rheumatology practice. Our findings suggest that future actions should be focused on the primary care level to improve referral to rheumatologists. In addition, the collection of real-world data seems essential to characterise the RA population, to improve disease management and to increase compliance with current treatment guidelines.

Rheumatoid arthritis; Biologics; Access to treatment; Qualitative research; Stakeholders