Table 1.

Barriers to use of COBRA therapy in clinical practice.

FeatureImplementation Package
Rheumatologist barrier*
  Workload

  1. Specialized COBRA therapy information booklet

  2. Preprinted prescription orders

  3. Example consult

  4. Refer to arthritis nurse

  Anticipated negative reaction of patientDissemination of focus group results among rheumatologists and arthritis nurses: patients are positive about intensive combination therapy such as COBRA. Taking many pills is not regarded as a problem, if this improves longterm prognosis. A decrease in the amount of pills over time is highly appreciated
  Fear of prednisoloneDissemination of scientific articles of the COBRA and BeSt trial
Patient barrier
  Comfort

  1. Provide information booklet for reference and leaflet for summary

  2. Offer additional support from an arthritis nurse

  Negative perception of prednisoloneEmphasize the temporary nature (using visual aids in the booklet and leaflet)
  Amount of pillsEmphasize the temporary nature (using visual aids in the booklet and leaflet)
Arthritis nurse barrier
  Knowledge on COBRA therapy

  1. Provide information material about COBRA therapy

  2. Provide education

  • ↵* Assessed in focus group discussions and interviews.