A Population‐Based Study Evaluating Retention in Rheumatology Care Among Patients With Rheumatoid Arthritis
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 iden...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-07-01
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| Series: | ACR Open Rheumatology |
| Online Access: | https://doi.org/10.1002/acr2.11442 |
| _version_ | 1828266046122885120 |
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| author | Claire E. H. Barber Diane Lacaille Ruth Croxford Cheryl Barnabe Deborah A. Marshall Michal Abrahamowicz Hui Xie J. Antonio Avina‐Zubieta John M. Esdaile Glen Hazlewood Peter Faris Steven Katz Paul MacMullan Dianne Mosher Jessica Widdifield |
| author_facet | Claire E. H. Barber Diane Lacaille Ruth Croxford Cheryl Barnabe Deborah A. Marshall Michal Abrahamowicz Hui Xie J. Antonio Avina‐Zubieta John M. Esdaile Glen Hazlewood Peter Faris Steven Katz Paul MacMullan Dianne Mosher Jessica Widdifield |
| author_sort | Claire E. H. Barber |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T04:47:46Z |
| format | Article |
| id | doaj.art-46e58c5c45814921b278af47fc450d58 |
| institution | Directory Open Access Journal |
| issn | 2578-5745 |
| language | English |
| last_indexed | 2024-04-13T04:47:46Z |
| publishDate | 2022-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | ACR Open Rheumatology |
| spelling | doaj.art-46e58c5c45814921b278af47fc450d582022-12-22T03:01:48ZengWileyACR Open Rheumatology2578-57452022-07-014761362210.1002/acr2.11442A Population‐Based Study Evaluating Retention in Rheumatology Care Among Patients With Rheumatoid ArthritisClaire E. H. Barber0Diane Lacaille1Ruth Croxford2Cheryl Barnabe3Deborah A. Marshall4Michal Abrahamowicz5Hui Xie6J. Antonio Avina‐Zubieta7John M. Esdaile8Glen Hazlewood9Peter Faris10Steven Katz11Paul MacMullan12Dianne Mosher13Jessica Widdifield14University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada Vancouver British Columbia CanadaArthritis Research Canada and University of British Columbia Vancouver British Columbia CanadaICES Toronto CanadaUniversity of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada Vancouver British Columbia CanadaUniversity of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada Vancouver British Columbia CanadaArthritis Research Canada, Vancouver, British Columbia, Canada, and McGill University Montreal Quebec CanadaArthritis Research Canada, Vancouver British Columbia, Canada, and Simon Fraser University Burnaby British Columbia CanadaArthritis Research Canada and University of British Columbia Vancouver British Columbia CanadaArthritis Research Canada and University of British Columbia Vancouver British Columbia CanadaUniversity of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada Vancouver British Columbia CanadaAlberta Health Services Calgary AlbertaUniversity of Alberta Edmonton Alberta CanadaUniversity of Calgary Calgary Alberta CanadaUniversity of Calgary Calgary Alberta CanadaICES, University of Toronto, and Sunnybrook Research Institute, Holland Bone and Joint Research Program Toronto CanadaObjective 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.https://doi.org/10.1002/acr2.11442 |
| spellingShingle | Claire E. H. Barber Diane Lacaille Ruth Croxford Cheryl Barnabe Deborah A. Marshall Michal Abrahamowicz Hui Xie J. Antonio Avina‐Zubieta John M. Esdaile Glen Hazlewood Peter Faris Steven Katz Paul MacMullan Dianne Mosher Jessica Widdifield A Population‐Based Study Evaluating Retention in Rheumatology Care Among Patients With Rheumatoid Arthritis ACR Open Rheumatology |
| title | A Population‐Based Study Evaluating Retention in Rheumatology Care Among Patients With Rheumatoid Arthritis |
| title_full | A Population‐Based Study Evaluating Retention in Rheumatology Care Among Patients With Rheumatoid Arthritis |
| title_fullStr | A Population‐Based Study Evaluating Retention in Rheumatology Care Among Patients With Rheumatoid Arthritis |
| title_full_unstemmed | A Population‐Based Study Evaluating Retention in Rheumatology Care Among Patients With Rheumatoid Arthritis |
| title_short | A Population‐Based Study Evaluating Retention in Rheumatology Care Among Patients With Rheumatoid Arthritis |
| title_sort | population based study evaluating retention in rheumatology care among patients with rheumatoid arthritis |
| url | https://doi.org/10.1002/acr2.11442 |
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