3.8 Article

A Population-Based Study Evaluating Retention in Rheumatology Care Among Patients With Rheumatoid Arthritis

期刊

ACR OPEN RHEUMATOLOGY
卷 4, 期 7, 页码 613-622

出版社

WILEY
DOI: 10.1002/acr2.11442

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资金

  1. ICES - Ontario Ministry of Health (MOH)
  2. Ministry of Long-Term Care (MLTC)
  3. Canadian Institutes for Health Research (CIHR) [PJT169194]
  4. Arthritis Society Stars Career Development Award - Canadian Institutes of Health Research-Institute of Musculoskeletal Health [STAR-190611/CIHR SI2-169745]
  5. Arthritis Society Stars Career Development Award [STAR-19-0610]
  6. Arthur J.E. Child Chair in Rheumatology
  7. Canada Research Chair in Health Systems and Services Research

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This study assessed adherence to system-level performance measures in rheumatology care for patients with rheumatoid arthritis (RA). The results showed a decline in the percentage of patients with annual visits over time. Factors such as age, gender, and healthcare resources were found to affect the likelihood of receiving ongoing rheumatology care.
Objective 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). Methods 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. Results 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. Conclusion 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.

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