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Schletzbaum M, Powell WR, Garg S, Kramer J, Astor BC, Gilmore-Bykovskyi A, Kind AJ, Bartels CM. Receipt of rheumatology care and lupus-specific labs among young adults with systemic lupus erythematosus: A US Medicare retention in care cohort study. Lupus 2024; 33:804-815. [PMID: 38631342 PMCID: PMC11139576 DOI: 10.1177/09612033241247905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE In systemic lupus erythematosus, poor disease outcomes occur in young adults, patients identifying as Black or Hispanic, and socioeconomically disadvantaged patients. These identities and social factors differentially shape care access and quality that contribute to lupus health disparities in the US. Thus, our objective was to measure markers of care access and quality, including rheumatology visits (longitudinal care retention) and lupus-specific serology testing, by race and ethnicity, neighborhood disadvantage, and geographic context. METHODS This cohort study used a geo-linked 20% national sample of young adult Medicare beneficiaries (ages 18-35) with lupus-coded encounters and a 1-year assessment period. Retention in lupus care required a rheumatology visit in each 6-month period, and serology testing required ≥1 complement or dsDNA antibody test within the year. Multivariable logistic regression models were fit for visit-based retention and serology testing to determine associations with race and ethnicity, neighborhood disadvantage, and geography. RESULTS Among 1,036 young adults with lupus, 39% saw a rheumatologist every 6 months and 28% had serology testing. White beneficiaries from the least disadvantaged quintile of neighborhoods had higher visit-based retention than other beneficiaries (64% vs 30%-60%). Serology testing decreased with increasing neighborhood disadvantage quintile (aOR 0.80; 95% CI 0.71, 0.90) and in the Midwest (aOR 0.46; 0.30, 0.71). CONCLUSION Disparities in care, measured by rheumatology visits and serology testing, exist by neighborhood disadvantage, race and ethnicity, and region among young adults with lupus, despite uniform Medicare coverage. Findings support evaluating lupus care quality measures and their impact on US lupus outcomes.
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Affiliation(s)
- Maria Schletzbaum
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - W. Ryan Powell
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Shivani Garg
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Joseph Kramer
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Brad C. Astor
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Andrea Gilmore-Bykovskyi
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Amy J Kind
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
| | - Christie M Bartels
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, US
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Bammert P, Schüttig W, Novelli A, Iashchenko I, Spallek J, Blume M, Diehl K, Moor I, Dragano N, Sundmacher L. The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review. Int J Equity Health 2024; 23:37. [PMID: 38395914 PMCID: PMC10885500 DOI: 10.1186/s12939-024-02122-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use. METHODS We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)' recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered. RESULTS Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies. CONCLUSIONS Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.
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Affiliation(s)
- Philip Bammert
- Chair of Health Economics, Technical University of Munich, Munich, Germany.
| | - Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Anna Novelli
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Iryna Iashchenko
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Lausitz Center for Digital Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Miriam Blume
- Department of Epidemiology and Health Monitoring, Robert-Koch-Institute, Berlin, Germany
| | - Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Irene Moor
- Institute of Medical Sociology, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Munich, Germany
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Almaghlouth I, Almalag HM, Alzuhair H, Alsaigh R, Bedaiwi A, Hassen LM, Alzomia S, Alanazi B, Alabdulkareem AM, Alahmari S, Asfina KN, Khalil N, Omair MA, Bedaiwi M. Impact of telemedicine on disease activity assessment: A case-crossover study nested within a cohort of patients with systemic lupus erythematosus. Lupus 2023; 32:1610-1618. [PMID: 37921574 DOI: 10.1177/09612033231211855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
INTRODUCTION The utilisation of telemedicine has been rapidly growing among patients with rheumatic diseases, especially following the corona virus disease 2019 pandemic. Ease and convenience appear to dominate the reasons for this growth. However, the effects of this approach in patients with systemic lupus erythematosus (SLE) are yet to be revealed. In this study, we examined the effect of telemedicine on disease activity assessment and damage scores in patients with SLE. METHODS This case-crossover study was nested within a national prospective cohort of patients with SLE in Saudi Arabia. Patients with SLE were included if they fulfilled the Systemic Lupus International Collaborating Clinics classification criteria between March 2020 and March 2021 and were assessed at three time points with 3 months between assessments, according to the standardised protocol of this cohort. Telemedicine was conducted for the first evaluation, while in-person assessments were used at the second and third visits. The primary outcome was the difference in the SLE disease activity index 2000 (SLEDAI-2K) score. The primary analysis was conducted using the repeated measure model and adjusted for potential confounders, including demographics, medications, and changes in steroid doses. Several sensitivity analyses were conducted to mitigate selection and time-varying confounders. RESULTS A total of 92 participants were included in this study. Most patients were females (88%), with a mean (±standard deviation [SD]) age of 36 (±13) years. The mean (±SD) disease activity scores at baseline were as follows: SLEDAI-2K, 5 (±5); SLE responder index, 3.8 (±3.5); Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index, 1 (±1). The mean difference in SLEDAI-2K score was -1.641 (95% confidence interval -2.773 to -0.510, p = 0.005*) between telemedicine and follow-up visits. The results were consistent in all sensitivity analyses. CONCLUSION We found that telemedicine assessment was associated with a much higher disease activity score than subsequent assessments, which may suggest an overestimation of disease activity and later assessment accuracy. Cautious adoption has been suggested for SLE patients with active disease.
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Affiliation(s)
- Ibrahim Almaghlouth
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Haya M Almalag
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hajer Alzuhair
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rafif Alsaigh
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Asma Bedaiwi
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lena M Hassen
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Zoology Department, College of Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Sulaiman Alzomia
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Boshra Alanazi
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Saud Alahmari
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kazi Nur Asfina
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Najma Khalil
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- College of Medicine Research Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A Omair
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Bedaiwi
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Martz CD, Hunter EA, Kramer MR, Wang Y, Chung K, Brown M, Drenkard C, Lim SS, Chae DH. Pathways linking census tract typologies with subjective neighborhood disorder and depressive symptoms in the Black Women's Experiences Living with Lupus (BeWELL) Study. Health Place 2021; 70:102587. [PMID: 34116496 PMCID: PMC8328917 DOI: 10.1016/j.healthplace.2021.102587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/04/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022]
Abstract
Depression is a common comorbidity among Black women with systemic lupus erythematosus (SLE), an understudied autoimmune disease characterized by major racial and gender inequities. Research is needed that examines how area-level factors influence risk of depression in this population. Latent profile analysis revealed four neighborhood typologies among metropolitan Atlanta, Georgia census tracts that participants (n=438) in the Black Women's Experiences Living with Lupus (BeWELL) Study were living in: Integrated/High-SES, Moderately Segregated/Mid-SES, Highly Segregated/Mid-SES, and Highly Segregated/Low-SES. Structural equation models indicated that highly segregated census tracts were associated with the greatest levels of depression via increased subjective assessments of neighborhood disorder. Policies that invest in segregated areas and address physical and social aspects of the environment that contribute to neighborhood disorder may promote mental health among Black women with SLE.
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Affiliation(s)
- Connor D Martz
- Department of Human Development and Family Science, Auburn University, 203 Spidle Hall, Auburn, AL, 36849, USA.
| | - Evelyn A Hunter
- Department of Special Education, Rehabilitation, and Counseling, Auburn University, 2084 Haley Center, Auburn, AL, 36849, USA
| | - Michael R Kramer
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Yijie Wang
- Department of Human Development and Family Studies, Michigan State University, 552 W. Circle Dr, East Lansing, MI, 48824, USA
| | - Kara Chung
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA
| | - Michael Brown
- School of Kinesiology, Auburn University, 301 Wire Rd., Auburn, AL, 36849, USA
| | - Cristina Drenkard
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA; Department of Medicine, Division of Rheumatology, Emory University School of Medicine, 1658 Clifton Rd. A, Atlanta, GA, 30322, USA
| | - S Sam Lim
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA; Department of Medicine, Division of Rheumatology, Emory University School of Medicine, 1658 Clifton Rd. A, Atlanta, GA, 30322, USA
| | - David H Chae
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA
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Feldman CH, Speyer C, Ashby R, L Bermas B, Bhattacharyya S, Chakravarty E, Everett B, Ferucci E, Hersh AO, Marty FM, Merola JF, Ramsey-Goldman R, Rovin BH, Son MB, Tarter L, Waikar S, Yazdany J, Weissman JS, Costenbader KH. Development of a Set of Lupus-Specific, Ambulatory Care-Sensitive, Potentially Preventable Adverse Conditions: A Delphi Consensus Study. Arthritis Care Res (Hoboken) 2021; 73:146-157. [PMID: 31628721 DOI: 10.1002/acr.24095] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/15/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Individuals with systemic lupus erythematosus (SLE) are at high risk for infections and SLE- and medication-related complications. The present study was undertaken to define a set of SLE-specific adverse outcomes that could be prevented, or their complications minimized, if timely, effective ambulatory care had been received. METHODS We used a modified Delphi process beginning with a literature review and key informant interviews to select initial SLE-specific potentially preventable conditions. We assembled a panel of 16 nationally recognized US-based experts from 8 subspecialties. Guided by the RAND-UCLA Appropriateness Method, we held 2 survey rounds with controlled feedback and an interactive webinar to reach consensus regarding preventability and importance on a population level for a set of SLE-specific adverse conditions. In a final round, the panelists endorsed the potentially preventable conditions. RESULTS Thirty-five potential conditions were initially proposed; 62 conditions were ultimately considered during the Delphi process. The response rate was 100% for both survey rounds, 88% for the webinar, and 94% for final approval. The 25 SLE-specific conditions meeting consensus as potentially preventable and important on a population level fell into 4 categories: vaccine-preventable illnesses (6 conditions), medication-related complications (8 conditions), reproductive health-related complications (6 conditions), and SLE-related complications (5 conditions). CONCLUSION We reached consensus on a diverse set of adverse outcomes relevant to SLE patients that may be preventable if patients receive high-quality ambulatory care. This set of outcomes may be studied at the health system level to determine how to best allocate resources and improve quality to reduce avoidable outcomes and disparities among those at highest risk.
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Affiliation(s)
- Candace H Feldman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cameron Speyer
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rachel Ashby
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Brendan Everett
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Francisco M Marty
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joseph F Merola
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Brad H Rovin
- Ohio State University Wexner Medical Center, Columbus
| | - Mary Beth Son
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura Tarter
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sushrut Waikar
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Karen H Costenbader
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Arora S, Yazdany J. Use of Quality Measures to Identify Disparities in Health Care for Systemic Lupus Erythematosus. Rheum Dis Clin North Am 2020; 46:623-638. [PMID: 32981640 DOI: 10.1016/j.rdc.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Assessment of quality of care for people with systemic lupus erythematosus (SLE) provides opportunities to identify gaps in health care and address disparities. Poor access to specialty care has been shown to negatively impact care in SLE and is associated with poor disease outcomes. Racial/ethnic minorities and those with low socioeconomic status are at higher risk for poor access and lower quality of care. Quality measures evaluating processes of care have shown significant deficiencies in care of SLE patients across studies. High SLE patient volume correlates with better quality of care for providers in hospital and ambulatory settings.
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Affiliation(s)
- Shilpa Arora
- Division of Rheumatology, Rush University Medical Center, 1611 West Harrison Street, Suite 510, Chicago, IL 60612, USA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, 1001 Potrero Avenue, Suite 3300, San Francisco, CA 94110, USA.
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Anandarajah A. Designing an Intervention to Improve Management of High-Risk Lupus Patients Through Care Coordination. Rheum Dis Clin North Am 2020; 46:723-734. [PMID: 32981649 DOI: 10.1016/j.rdc.2020.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Health care disparities are a major cause for large discrepancies in health outcomes between different populations with systemic lupus erythematosus in the United States.A team-based model that incorporates a care coordination strategy in the management of high-risk lupus patients can provide an effective method to overcome the obstacles posed by health care disparities.Access, behavioral modification, community outreach programs, depression, and education are key aspects that need to be addressed when designing interventions to improve the quality of care for high-risk lupus patients.
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Affiliation(s)
- Allen Anandarajah
- Division of Allergy, Immunology & Rheumatology Division, University of Rochester Medical Center, 601 Elmwood Avenue, PO Box 695, Rochester, NY 14642, USA.
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Nyman E, Vaughan T, Desta B, Wang X, Barut V, Emmas C. Characteristics and Symptom Severity of Patients Reporting Systemic Lupus Erythematosus in the PatientsLikeMe Online Health Community: A Retrospective Observational Study. Rheumatol Ther 2020; 7:201-213. [PMID: 32008212 PMCID: PMC7021880 DOI: 10.1007/s40744-020-00195-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Online health communities and research networks such as PatientsLikeMe (PLM) capture patient perspectives of diseases, including systemic lupus erythematosus (SLE). We performed a retrospective observational study of data provided by patients in the PLM SLE community to characterize demographics, clinical characteristics, patient experience, and symptom impact. METHODS Adults who registered with PLM in 2011-2017 and reported SLE diagnosis and treatment with one or more SLE-related drug (antimalarials, immunosuppressives, corticosteroids, calcineurin inhibitors, or biologics) were included in the analysis. Information reported within 30 days from PLM registration was used to assess patient eligibility; demographics and clinical characteristics; and primary outcome measures of SLE treatments, symptoms, primary lupus manifestations, and comorbidities. RESULTS Among 21,101 PLM members included in this analysis, median ages at registration, onset of SLE symptoms, and SLE diagnosis were 46 years (interquartile range [IQR] 38-53, n = 21,101), 30 years (IQR 21-39; n = 6489), and 36 years (IQR 27-44; n = 6936), respectively. Most patients were female (96.8%, n = 20,370). Country of residence was reported by 19,502 patients (92.4%), of whom 18,491 (94.8%) were US residents. Race was recorded by 17,994 patients (85.3%), of whom 67.8% were white and 22.4% were black/African American. Patients reported a mean of 2.2 SLE-related medications, including antimalarials (83.8%), corticosteroids (78.8%), immunosuppressives (32.3%), and biologics (9.4%). Fatigue, pain, and joint pain were rated as moderate or severe by at least 80% of patients who reported these symptoms. Reported primary lupus manifestations and comorbidities included fibromyalgia (7.9%), discoid lupus (6.8%), lupus nephritis (6.3%), rheumatoid arthritis (4.8%), subacute cutaneous lupus (4.7%), central nervous system lupus (3.9%), Sjögren's syndrome (3.9%), and lupus pneumonitis (3.1%). CONCLUSIONS Age, sex, and race of patients in the PLM SLE community are broadly consistent with characteristics of the general SLE population in the United States. The PLM SLE population may provide valuable data on self-reported patient experience. Plain language summary available for this article.
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Affiliation(s)
| | - Timothy Vaughan
- Data Sciences, Cohen Veterans Bioscience, Cambridge, MA, USA
| | - Barnabas Desta
- Global Pricing and Market Access, AstraZeneca, Gaithersburg, MD, USA
| | - Xia Wang
- Data Science and AI, AstraZeneca, Gaithersburg, MD, USA
| | - Volkan Barut
- BioPharmaceuticals Medical, AstraZeneca, Luton, UK
| | - Cathy Emmas
- BioPharmaceuticals Medical, AstraZeneca, Luton, UK.
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Yelin E, Trupin L, Bunde J, Yazdany J. Poverty, Neighborhoods, Persistent Stress, and Systemic Lupus Erythematosus Outcomes: A Qualitative Study of the Patients' Perspective. Arthritis Care Res (Hoboken) 2019; 71:398-405. [PMID: 29781579 PMCID: PMC6249128 DOI: 10.1002/acr.23599] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/15/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To obtain the perspective of individuals with systemic lupus erythematosus (SLE) regarding the role of poverty, neighborhood, and chronic stress in SLE outcomes. METHODS Through annual structured interviews as part of the Lupus Outcomes Study, 723 persons with SLE were followed from 2003 to 2015 in order to establish the effect of combinations of poverty, persistent poverty, residence in an area of concentrated poverty, access to health care, and chronic stress on accumulated damage. We obtained a sample of 28 of the 723 individuals on the basis of household income, geography, and outcomes in their last interview, and administered qualitative interviews to explore their perspectives on the impact of these factors on SLE outcomes. The interviews were recorded, transcribed, and analyzed using a grounded theory approach. RESULTS Persons in poverty frequently reported that poverty necessitated a choice to deal with food, medical care, and housing insecurity on a daily basis and to relegate their management of SLE to occurrences of disease flares. They also reported that exposure to crime in their neighborhoods was a stressor that triggered worse disease activity. Affluent participants reported that neighborhood neither helped nor hindered dealing with SLE, because they relied on networks not tied to neighborhoods to deal with SLE. CONCLUSION Mitigating poverty and reducing exposure to crime through moving to safer neighborhoods are factors identified by individuals with SLE as potentially critical in disease outcomes.
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Affiliation(s)
- Edward Yelin
- Philip R Lee Institute for Health Policy Studies, UCSF
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, UCSF
- Institute for Research on Labor and Employment, UC, Berkeley
| | - Laura Trupin
- Philip R Lee Institute for Health Policy Studies, UCSF
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, UCSF
| | - Jared Bunde
- School of Nursing, Health Policy Program, UCSF
| | - Jinoos Yazdany
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, UCSF
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Yelin E, Yazdany J, Trupin L. Relationship Between Process of Care and a Subsequent Increase in Damage in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2017; 69:927-932. [PMID: 27477567 DOI: 10.1002/acr.22977] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/22/2016] [Accepted: 06/28/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate whether low ratings of interactions with providers and health plans in 2013 were associated with increased systemic lupus erythematosus (SLE) damage in 2015. METHODS Data were derived from the Lupus Outcomes Study (LOS) annual surveys and include items from the Consumer Assessment of Health Plans and Interpersonal Processes of Care Scale measuring dimensions of health care interactions. We used ordinary least squares regression to model the change in disease damage over a 2-year period, 2013-2015, as a function of ratings of multiple dimensions of interactions with providers and health plans, with and without adjustment for demographic characteristics, socioeconomic status, and SLE and overall health status, and logistic regression to estimate the effect of the same matrix of variables on the probability of experiencing a minimum clinically important increase in damage. RESULTS There were 566 LOS respondents who were followed from 2013-2015 and who rated their providers and health plans in 2013. After adjustment, persons with SLE rating their providers poorly in patient-provider communication experienced a significantly greater accrual of disease damage (odds ratio [OR] 0.23 [95% confidence interval (95% CI) 0.09-0.38]) and were more likely to experience a minimum clinically important increase in damage (OR 2.35 [95% CI 1.25-4.39]). After adjustment, those rating their health plan poorly on care coordination experienced a significantly greater accrual of disease damage (OR 0.19 [95% CI 0.03-0.35]) and were more likely to experience a minimum clinically important increase in damage (OR 2.20 [95% CI 1.12-4.34]). CONCLUSION Poor patient-provider communication and care coordination may result in increased disease damage.
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Affiliation(s)
- Edward Yelin
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Jinoos Yazdany
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Laura Trupin
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
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Golder V, Morand EF, Hoi AY. Quality of Care for Systemic Lupus Erythematosus: Mind the Knowledge Gap. J Rheumatol 2017; 44:271-278. [DOI: 10.3899/jrheum.160334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2016] [Indexed: 02/03/2023]
Abstract
Systemic lupus erythematosus (SLE) is a prototypical chronic multiorgan autoimmune disorder that can lead to significant burden of disease and loss of life expectancy. The disease burden is the result of a complex interplay between genetic, biologic, socioeconomic, and health system variables affecting the individual. Recent advances in biological understanding of SLE are yet to translate to transformative therapies, and genetic and socioeconomic variables are not readily amenable to intervention. In contrast, healthcare quality, a variable readily amenable to change, has been inadequately addressed in SLE, despite evidence in other chronic diseases that quality of care is strongly associated with patient outcomes. This article will analyze the available literature on the quality of care relevant to SLE, identify knowledge gaps, and suggest ways to address this in future research.
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Williams EM, Ortiz K, Flournoy-Floyd M, Bruner L, Kamen D. Systemic lupus erythematosus observations of travel burden: A qualitative inquiry. Int J Rheum Dis 2015; 18:751-60. [PMID: 26176174 DOI: 10.1111/1756-185x.12614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Explorations of travel impediments among patients suffering from rheumatic diseases have been very limited. Research has consistently indicated a shortage of rheumatologists, resulting in patients potentially having to travel long distances for care. The purpose of our study was to explore how systemic lupus erythematosus (SLE) patients experience travel issues differentially by race and socio-economic status. METHODS We conducted semi-structured interviews and a brief demographic survey with 10 patients diagnosed with SLE. Interview transcripts were coded and analyzed using NVivo Analysis Software to facilitate the reporting of recurrent themes and supporting quotations, and an initial codebook was independently developed by two researchers on the study team and then verified together. RESULTS Patients described three major areas of concern with respect to travel burden in accessing their rheumatologists: reliance on caregivers; meeting financial priorities; and pain and physical limitations. CONCLUSIONS Our data suggest general traveling challenges interfering with medical appointment compliance for several participants and the importance of socio-economic issues when considering travel issues. This study highlights an important area with implications for adherence to medical appointments and participation in research among patients with SLE.
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Affiliation(s)
- Edith M Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Kasim Ortiz
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Minnjuan Flournoy-Floyd
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Larisa Bruner
- Office of Public Health Practice, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Yelin E, Yazdany J, Tonner C, Trupin L, Criswell LA, Katz P, Schmajuk G. Interactions between patients, providers, and health systems and technical quality of care. Arthritis Care Res (Hoboken) 2015; 67:417-24. [PMID: 25132660 PMCID: PMC4320034 DOI: 10.1002/acr.22427] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/29/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Prior studies have established disparities by race/ethnicity and socioeconomic status (SES) in the kind, quantity, and technical quality of systemic lupus erythematosus (SLE) care and outcomes. In this study we evaluate whether disparities exist in assessments of interactions with health care providers and health plans and whether such interactions affect the technical quality of SLE care. METHODS Data derive from the Lupus Outcomes Study (LOS). Principal data collection is an annual structured phone interview including items from the Consumer Assessment of Health Plans and Interpersonal Processes of Care Scale measuring dimensions of health care interactions. We use general estimating equations to assess whether disparities exist by race/ethnicity and SES in being in the lowest quartile of ratings of such interactions and whether ratings in the lowest quartile of interactions are associated with technical quality of care after adjustment for sociodemographic and disease characteristics. RESULTS In the 2012 LOS interview, there were 793 respondents, of whom 640 had ≥1 visit to their principal SLE provider. Nonwhite race/ethnicity and education were not associated with low ratings on any dimension of provider or system interaction; poverty was associated only with low ratings of health plan interactions. After adjustment for demographics, SLE status, and health care variables, ratings in the lowest quartile on all dimensions were associated with significantly lower technical quality of care. CONCLUSION Ratings in the lowest quartile on all dimensions of interactions with providers and the health care system were associated with lower technical quality of care, potentially resulting in poorer SLE outcomes.
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Affiliation(s)
- Edward Yelin
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
- Philip R. Lee Institute for Health Policy Studies, UCSF
| | - Jinoos Yazdany
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
| | - Chris Tonner
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
- Philip R. Lee Institute for Health Policy Studies, UCSF
| | - Laura Trupin
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
- Philip R. Lee Institute for Health Policy Studies, UCSF
| | | | - Patricia Katz
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
- Philip R. Lee Institute for Health Policy Studies, UCSF
| | - Gabriela Schmajuk
- The Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center
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Badley EM, Canizares M, Gunz AC, Davis AM. Visits to Rheumatologists for Arthritis: The Role of Access to Primary Care Physicians, Geographic Availability of Rheumatologists, and Socioeconomic Status. Arthritis Care Res (Hoboken) 2015; 67:230-9. [DOI: 10.1002/acr.22413] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 07/15/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth M. Badley
- Toronto Western Research Institute, University of Toronto, and Institute for Clinical Evaluative Sciences, Toronto; Ontario Canada
| | - Mayilee Canizares
- Toronto Western Research Institute and University of Toronto, Toronto; Ontario Canada
| | - Anna C. Gunz
- University of Western Ontario, London; Ontario Canada
| | - Aileen M. Davis
- Toronto Western Research Institute and University of Toronto, Toronto; Ontario Canada
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Kim SS, Mancuso CA, Huang WT, Erkan D. Social capital: a novel platform for understanding social determinants of health in systemic lupus erythematosus. Lupus 2014; 24:122-9. [PMID: 25199806 DOI: 10.1177/0961203314550224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this paper is to introduce the concept of social capital as a unique and distinct entity from the traditional psychosocial factors of social support, depressive symptoms, and self-efficacy in systemic lupus erythematosus (SLE) patients, and to evaluate how social capital varies in an SLE sample according to demographic, clinical, and psychosocial variables. METHODS In a cross-sectional study, SLE patients completed the Adapted Social Capital Assessment Tool (A-SCAT), which measures cognitive and structural social capital. Patients also completed measures of social support, depressive symptoms, and SLE self-efficacy. Correlations were evaluated between social capital scores and demographic, clinical, and psychosocial variables. RESULTS We recruited 89 patients (mean age: 39 ± 15 years old, 83 (93): female; mean SLEDAI: 4; mean SLICC 1). The mean A-SCAT score was 34 ± 15 (normal: 0-71); higher scores were associated with female sex, older age, higher education, Caucasian race, and non-Medicaid insurance (p ≤ 0.03 for all); associations were attributable to structural social capital. Social capital was not associated with depressive symptoms, self-efficacy, or affectionate and interaction social support, but was associated with informational and tangible social support (r = 0.39, r = 0.26, respectively, p ≤ 0.02). There were no associations between SLEDAI and SLICC and social capital, social support, and depressive symptoms. CONCLUSIONS Social capital is a novel construct that, like other traditional psychosocial measures, addresses aspects of SLE not reflected by markers of disease activity. Social capital, however, is distinct from traditional psychosocial measures and offers a new platform on which ideas of social connectedness can broaden our understanding of health and chronic illness.
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Affiliation(s)
- S S Kim
- Department of Rheumatology, Lehigh Valley Health Network, USA
| | - C A Mancuso
- Department of Rheumatology, Hospital for Special Surgery, USA
| | - W-T Huang
- Department of Rheumatology, Hospital for Special Surgery, USA
| | - D Erkan
- Department of Rheumatology, Hospital for Special Surgery, USA
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Bartels CM, Ramsey-Goldman R. Editorial: Updates in US systemic lupus erythematosus epidemiology: Tales of two cities. Arthritis Rheumatol 2014; 66:242-5. [PMID: 24504794 DOI: 10.1002/art.38240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 10/15/2013] [Indexed: 12/29/2022]
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Socioeconomic status. The relationship with health and autoimmune diseases. Autoimmun Rev 2014; 13:641-54. [PMID: 24418307 DOI: 10.1016/j.autrev.2013.12.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 12/24/2013] [Indexed: 12/15/2022]
Abstract
Socioeconomic status (SES) is a hierarchical social classification associated with different outcomes in health and disease. The most important factors influencing SES are income, educational level, occupational class, social class, and ancestry. These factors are closely related to each other as they present certain dependent interactions. Since there is a need to improve the understanding of the concept of SES and the ways it affects health and disease, we review herein the tools currently available to evaluate SES and its relationship with health and autoimmune diseases.
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Lawson EF, Yazdany J. Healthcare quality in systemic lupus erythematosus: using Donabedian's conceptual framework to understand what we know. ACTA ACUST UNITED AC 2012; 7:95-107. [PMID: 22448191 DOI: 10.2217/ijr.11.65] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Healthcare quality improvement has the potential to reduce the striking disparities in health outcomes among patients with systemic lupus erythematosus (SLE). Donabedian's framework for assessment of healthcare quality, which divides factors impacting quality into structures, processes and outcomes, provides a theoretical framework for research and interventions in quality improvement. This review applies Donabedian's model to current research describing quality of care in SLE, highlighting structures and processes that may lead to improved outcomes. Work remains to be done to develop meaningful metrics to assess quality and to understand the structures and processes that improve outcomes. Quality indicators have emerged as an important tool to measure quality, but further validation is required to define their validity and feasibility in clinical practice, as well as their association with improved outcomes. Implementation science also shows promise as a means to create meaningful systematic improvements in healthcare quality for patients with SLE.
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Affiliation(s)
- Erica F Lawson
- University of California, San Francisco, Department of Pediatrics, Division of Rheumatology, 3333 California Street, Box 0920, San Francisco, CA 94143, USA
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Beckerman NL, Auerbach C, Blanco I. Psychosocial dimensions of SLE: implications for the health care team. J Multidiscip Healthc 2011; 4:63-72. [PMID: 21594059 PMCID: PMC3093952 DOI: 10.2147/jmdh.s19303] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Indexed: 11/23/2022] Open
Abstract
Background: The purpose of this exploratory study was threefold, ie, to clarify the unique psychosocial challenges facing those living with systemic lupus erythematosus (SLE), to distinguish which sociodemographic variables impact the lives of SLE patients, and generate knowledge regarding the way patients perceive SLE medication regimens. Methods: This was a cross-sectional exploratory study in 378 patients diagnosed with SLE and receiving services from the SLE Lupus Foundation in New York City. In addition to sociodemographic variables, the instrument used consisted of two scales, ie, the Systemic Lupus Erythematosus Needs Questionnaire (SLENQ) and the Multidimensional Health Locus of Control Scale, as well as questions regarding subjective perceptions of side effects from SLE medication. Results: The highest general cause of self-reported depressive and anxious feelings was changes in appearance due to SLE, and limitations in physical abilities due to SLE (primarily from muscle and joint pain). The higher the sense of control over SLE, the less likely respondents were to report feeling depressed and anxious. African-American and Hispanic SLE patients reported a higher level of unmet psychological needs due to SLE than did their other ethnic counterparts. Weight gain and hair loss were the most likely medication side effects and also the most likely causes of SLE-related depression and anxiety. Conclusion: Those living with SLE are at risk for feelings of depression and anxiety. African-American and Hispanic women are at higher risk for these emotional states. Comprehensive assessment across the disciplines should screen this group of patients for depression and anxiety, and be prepared to refer them to patient education and social work counseling as indicated.
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