Barber Claire E H, Lacaille Diane, Croxford Ruth, Barnabe Cheryl, Marshall Deborah A, Abrahamowicz Michal, Xie Hui, Avina-Zubieta J Antonio, Esdaile John M, Hazlewood Glen, Faris Peter, Katz Steven, MacMullan Paul, Mosher Dianne, Widdifield Jessica
University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada.
Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada.
ACR Open Rheumatol. 2022 Jul;4(7):613-622. doi: 10.1002/acr2.11442. Epub 2022 May 5.
The study objective was to assess adherence to system-level performance measures measuring retention in rheumatology care and disease modifying anti-rheumatic drug (DMARD) treatment in rheumatoid arthritis (RA).
We used a validated health administrative data case definition to identify individuals with RA in Ontario, Canada, between 2002 and 2014 who had at least 5 years of potential follow-up prior to 2019. During the first 5 years following diagnosis, we assessed whether patients were seen by a rheumatologist yearly and the proportion dispensed a DMARD yearly (in those aged ≥66 for whom medication data were available). Multivariable logistic regression analyses were used to estimate the odds of remaining under rheumatologist care.
The cohort included 50,883 patients with RA (26.1% aged 66 years and older). Over half (57.7%) saw a rheumatologist yearly in all 5 years of follow-up. Sharp declines in the percentage of patients with an annual visit were observed in each subsequent year after diagnosis, although a linear trend to improved retention in rheumatology care was seen over the study period (P < 0.0001). For individuals aged 66 years or older (n = 13,293), 82.1% under rheumatologist care during all 5 years after diagnosis were dispensed a DMARD annually compared with 31.0% of those not retained under rheumatology care. Older age, male sex, lower socioeconomic status, higher comorbidity score, and having an older rheumatologist decreased the odds of remaining under rheumatology care.
System-level improvement initiatives should focus on maintaining ongoing access to rheumatology specialty care. Further investigation into causes of loss to rheumatology follow-up is needed.
本研究的目的是评估在类风湿关节炎（RA）中，对衡量风湿病护理留存率和改善病情抗风湿药（DMARD）治疗的系统层面性能指标的依从性。
我们使用经过验证的健康管理数据病例定义，来识别2002年至2014年期间在加拿大安大略省患有RA且在2019年之前至少有5年潜在随访期的个体。在诊断后的前5年中，我们评估患者是否每年看一次风湿病专科医生，以及每年接受DMARD治疗的比例（对于年龄≥66岁且有可用用药数据的患者）。采用多变量逻辑回归分析来估计仍接受风湿病专科医生护理的几率。
该队列包括50883例RA患者（26.1%年龄在66岁及以上）。超过一半（57.7%）的患者在整个5年随访期内每年都看风湿病专科医生。在诊断后的每一年，年度就诊患者的百分比都急剧下降，尽管在研究期间观察到在风湿病护理中留存率有改善的线性趋势（P<0.0001）。对于66岁及以上的个体（n = 13293），在诊断后的所有5年中接受风湿病专科医生护理的患者中，82.1%每年接受DMARD治疗，而未接受风湿病专科护理的患者中这一比例为31.0%。年龄较大、男性、社会经济地位较低、合并症评分较高以及风湿病专科医生年龄较大，都会降低接受风湿病专科护理的几率。
系统层面的改进举措应侧重于维持持续获得风湿病专科护理的机会。需要进一步调查失去风湿病随访的原因。
