Predictors of health care drop-out in an inception cohort of patients with early onset rheumatoid arthritis

Abstract

BackgroundRA patients who eventually dropped out of treatment and out of the health care system had potentially disastrous consequences for their health-related quality-of-life outcomes. Objectives of the study were to identify predictors of health care drop out (HDO) in an inception and ongoing cohort of patients with recent onset RA.MethodsCharts from patients attending an early arthritis clinic from February 2004 to December 2015, and standardized follow-up evaluations were reviewed. Patients with HDO (cases) were defined when they did not return back to the clinic for a schedule visit for at least one year. Persistence with therapy was defined as length of time patients complied with RA-treatment. A case-control nested within a cohort design was used to compare baseline and cumulative (up to HDO or equivalent follow-up) variables between cases and paired controls (patients compliant with scheduled visits). Cox regression analysis was used to investigate predictors of HDO. The study was approved by the Institutional Review Board and patients gave written informed consent to have their data published.ResultsData from 170 patients (89.4% female, [mean±SD] age: 38.2±12.6 years) with ≥1 year of follow-up were analyzed; up to December 2015, (median, interquartile rage) follow-up was 86.6 months (43.2–123) during which 35 (20.6%) patients had HDO after 41.1 months (12.1–58.7). Baseline and cumulative variables related to disease activity, treatment and persistence with therapy entered regression models; cumulative number of flares, number of disease-modifying anti-rheumatic drugs /patient and persistence <50% emerged as predictors of HDO. Five cases returned back after (median, range) drop out time of 3.8 years (2.3–5.8); they exhibited higher disability and poorer function than paired controls and outcomes were sustained up to their last follow-up.ConclusionsIn a real clinical setting of an EAC, failure to control disease activity, intensive treatment and poor persistence with therapy predicted HDO. Abandonment of health care had a negative impact on patient outcomes and was sustained even after health care was reinitiated.

Early persistence on therapy impacts drug-free remission: a case-control study in a cohort of Hispanic patients with recent-onset rheumatoid arthritis

“…Previous literature reviews highlight that among patients with RA, adherence to DMARDs is suboptimal, and poor adherence affects 20 to 70% of the patients during their follow-up [17][18][19][20][21]. Inadequate medication adherence includes three major components (persistence, initiation adherence, and execution adherence) and causes a negative impact on the different patient and physicianreported outcomes, which our group has confirmed in Hispanic RA patients [17][18][19][20][21][22][23][24][25]. Meanwhile, the impact of medication adherence and its components on DFR, a realistic and achievable goal, has not been previously examined.…”

“…Patients with RA were identified from the early arthritis clinic of a national referral center for rheumatic diseases located in Mexico City, the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Patients entering the clinic had been previously described [23][24][25]. They had a disease duration of less than a year when first evaluated and were assessed every 2 months during the first 2 years of follow-up.…”

“…At study entry, the primary rheumatologist recorded a complete medical history, demographic data, and disease-specific auto-antibodies (rheumatoid factor [RF] and antibodies to citrullinated proteins [ACPA]). Standardized follow-up evaluations included extended joint counts, patient (PROs)-and physician-reported outcomes, comorbidity, treatment assessment, laboratory parameters, and hand and feet X-rays (on an annual basis) [23][24][25].…”

Early referral and control of disease’s flares prevent Orthopedic and Hand Surgery Indication (OHSI) in a dynamic cohort of Hispanic early rheumatoid arthritis patients

“…At baseline evaluation, a complete medical history and demographic data were recorded along with rheumatoid factor (RF) and antibodies to cyclic citrullinated peptides (ACCP). Follow-up evaluations were standardized and included prospective assessments of swollen and tender joint counts, patient- and physician-reported outcomes [ 2 , 3 ], extensive disease activity evaluation, comorbidity, treatment and persistence with therapy; complete laboratory parameters were also determined. Hand and feet X-rays were performed at baseline and thereafter every year.…”

“…Rheumatoid arthritis (RA) patients from Latin-America present distinctive epidemiological, serological and phenotypic characteristics when compared to Caucasians patients, and these are known to impact patient outcomes [ 1 – 3 ]. In addition, treating RA to target (T2T) has become an internationally agreed standard of good practice [ 4 ] although the implementation of such strategy may be restricted in developing countries and non-universal health care systems where adherence to treatment may be dramatically compromised [ 5 , 6 ].…”