Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.
Int J Rheum Dis. 2019 Jul;22(7):1233-1238. doi: 10.1111/1756-185X.13580. Epub 2019 Apr 16.
The aims of this study were to: (a) measure the proportion of CARTaGENE rheumatoid arthritis (RA) patients fulfilling pre-specified quality indicators (ie disease-modifying antirheumatic drug [DMARD] use, regular follow up, use of folate supplementation, use of vitamin D and calcium, exercise and smoking status); and (b) examine variation in DMARD use with respect to patient age, sex, education and income.
A cohort of RA patients was constructed based on the CARTaGENE survey and health administrative database. CARTaGENE is a large, established, population-based study which recruited 19 995 participants from four metropolitan regions in Quebec. Six quality indicators (QI) were assessed; four pertained to RA management and treatment received (use of DMARD therapy, annual medical visits, use of folate supplementation with methotrexate therapy, and use of calcium and vitamin D in steroid-exposed patients) and two pertained to lifestyle factors (physical activity and smoking cessation). QI were reported in terms of proportion of patients fulfilling them. Bayesian logistic regression analyses were preformed to investigate potential variation with DMARD use.
Our cohort included 142 RA patients. The QI that pertain to RA pharmacotherapy and medical management ranged 60-80%. Regarding the QI focusing on lifestyle factors, 55% of patients reported performing moderate physical activity and only 16.6% reported current smoking. Results from the Bayesian logistic regression showed no definite associations between DMARD use and patient characteristics (age, education, income and sex).
Our findings suggest a seemingly modest performance of Quebec's health-care system for RA patients, with respect to these QI.
本研究旨在：(a) 测量符合特定质量指标的 CARTaGENE 类风湿关节炎 (RA) 患者的比例（即疾病修饰抗风湿药物 [DMARD] 的使用、定期随访、叶酸补充剂的使用、维生素 D 和钙的使用、运动和吸烟状况）；(b) 检查 DMARD 使用与患者年龄、性别、教育程度和收入的关系。
基于 CARTaGENE 调查和健康管理数据库构建了一个 RA 患者队列。CARTaGENE 是一项大型的、成熟的基于人群的研究，从魁北克省的四个大都市区招募了 19995 名参与者。评估了六个质量指标（QI）；其中四个与 RA 管理和治疗有关（DMARD 治疗的使用、每年的医疗就诊、叶酸补充剂与甲氨蝶呤治疗的使用，以及在接受皮质类固醇治疗的患者中使用钙和维生素 D），另外两个与生活方式因素有关（身体活动和戒烟）。QI 的报告以符合它们的患者比例来表示。采用贝叶斯逻辑回归分析来研究与 DMARD 使用的潜在差异。
我们的队列包括 142 名 RA 患者。与 RA 药物治疗和医学管理有关的 QI 范围在 60-80%之间。关于侧重于生活方式因素的 QI，55%的患者报告进行适度的身体活动，只有 16.6%的患者报告目前吸烟。贝叶斯逻辑回归的结果显示，DMARD 使用与患者特征（年龄、教育程度、收入和性别）之间没有明确的关联。
我们的研究结果表明，在这些 QI 方面，魁北克省的医疗保健系统对 RA 患者的表现似乎并不理想。
