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Granath A, Pettersson S, Gunnarsson I, Welin E, Dahlberg K. How is the patient perspective captured in ANCA-associated vasculitis research? An integrative review. Rheumatol Adv Pract 2023; 7:rkad092. [PMID: 37954916 PMCID: PMC10637867 DOI: 10.1093/rap/rkad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023] Open
Abstract
Objective The aim was to describe how the patient perspective is captured in clinical research on ANCA-associated vasculitis (AAV). Methods This integrative review included 2149 publications found in four different databases and manual searches. After screening, 156 articles remained. All articles were sorted and categorized, and 77 original articles were analysed further. Results The patient perspective was captured with patient-reported outcome measures (PROMs), single-item questionnaires, project-specific questionnaires and interviews. The most common aspects measured were health-related quality of life, anxiety and depression, and fatigue, and the least common were lifestyle habits, relationships and self-management. Conclusion The patient perspective was captured predominantly with generic PROMs and occasionally with a qualitative approach. AVV is a lifelong disease, and the results from this review show that not all aspects of importance to patients are covered with the PROMs used in research. Future studies should include the areas that are the most important for patients.
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Affiliation(s)
- Annika Granath
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Centre for Innovation, Research and Education, Region Vastmanland, Vastmanland Hospital Vasteras, Sweden
| | - Susanne Pettersson
- Rheumatology Unit, Inflammation and Ageing Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Iva Gunnarsson
- Rheumatology Unit, Inflammation and Ageing Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Welin
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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2
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Cao B, Hogan SL, Derebail VK, Ehlert A, Thorpe CT. Polypharmacy in US Medicare beneficiaries with antineutrophil cytoplasmic antibody vasculitis. J Manag Care Spec Pharm 2023; 29:770-781. [PMID: 37404075 PMCID: PMC10387912 DOI: 10.18553/jmcp.2023.29.7.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND: Treatment requirements of antineutrophil cytoplasmic autoantibody vasculitis (AV) and high comorbidity burden among patients with AV may lead to higher potential for polypharmacy and its associated adverse outcomes, including adverse drug events, nonadherence, drug-drug interactions, and higher costs. Medication burden and risk factors associated with polypharmacy in patients with AV have not been well-characterized. OBJECTIVE: To characterize medication burden and examine prevalence of and risk factors for polypharmacy in the first year after diagnosis with AV. METHODS: We conducted a retrospective cohort study using 2015-2017 Medicare claims to identify incident cases of AV. We counted the number of unique generic products dispensed to patients in each of the 4 quarters after diagnosis and categorized medication count as high (≥10 medications), moderate (5-9 medications), or minimal or no polypharmacy (<5 medications). We used multinomial logistic regression to examine associations of predisposing, enabling, and medical need factors with having high or moderate polypharmacy. RESULTS: In 1,239 Medicare beneficiaries with AV, high or moderate polypharmacy was most common in the first quarter after diagnosis (83.7%), with 43.2% taking 5 - 9 medications and 40.5% taking at least 10. The odds of high polypharmacy were greater in all quarters for patients with eosinophilic granulomatosis with polyangiitis compared with granulomatosis with polyangiitis, ranging from 2.02 (95% CI = 1.18 - 3.46) in the third quarter to 2.96 (95% CI = 1.64-5.33) in the second quarter. Older age, diabetes, chronic kidney disease, obesity, a higher Charlson Comorbidity Index score, coverage with Medicaid/Part D low-income subsidy, and living in areas with low education or persistent poverty were risk factors for high or moderate polypharmacy. CONCLUSIONS: Medicare beneficiaries with newly diagnosed AV experienced a high medication burden, with more than 40% taking at least 10 medications and the highest rates among those with eosinophilic granulomatosis with polyangiitis. Patients with AV may benefit from medication therapy management interventions to manage complex drug regimens and reduce risks associated with polypharmacy. DISCLOSURES: Dr Derebail receives personal fees from Travere Therapeutics, Pfizer, Bayer, Forma Therapeutics, UpToDate, outside of the submitted work. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health or the Department of Veterans Affairs. Dr Thorpe receives royalties from SAGE Publishing for activities unrelated to the submitted work. This research is supported by internal funds from the University of North Carolina, as well as the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award number R21AI160606 (PI: C. Thorpe).
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Affiliation(s)
- Binxin Cao
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Susan L Hogan
- UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill
| | - Vimal K Derebail
- UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill
| | - Alexa Ehlert
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Carolyn T Thorpe
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
- Veterans Affairs Pittsburgh Healthcare System, PA
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3
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Deshields TL, Penalba V, Arroyo C, Tan B, Tippey A, Amin M, Miller R, Nelson A. The relationship between response style and symptom reporting in cancer patients. Support Care Cancer 2023; 31:312. [PMID: 37126138 DOI: 10.1007/s00520-023-07761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 04/16/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE Patient-reported outcomes are considered the gold standard for documenting treatment-related toxicities and cancer-related symptoms in the management of oncology patients. Poor concordance between patients and health care professionals (HCPs) on patients' symptoms has been documented. The purpose of this study is to examine the association between social desirability, a response style, and symptom reporting in a colorectal cancer clinic. METHODS Patients being treated for colorectal cancer completed a social desirability measure and a symptom measure before their appointment in the oncology clinic. The HCP who saw the patient completed a symptom measure for the patient after the clinic visit. RESULTS One hundred sixty-nine patients consented to participate in the study. The majority of the patients had stage 4 disease. There was a statistically significant positive correlation between social desirability and overall reported symptom burden. There was a statistically significant negative correlation between social desirability and concordance between the patient and the HCP on the patient's symptoms. Social desirability scores were stable over the course of 1 year. CONCLUSION Sensitivity to social desirability effects seems to play an important role in patient self-report of symptoms. As social desirability is a stable quality, patients sensitive to it may be persistently at risk for undertreatment of symptoms due to limited symptom reporting.
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Affiliation(s)
- Teresa L Deshields
- Rush University Cancer Center, Rush University College of Medicine, Chicago, IL, USA.
| | | | - Cassandra Arroyo
- Department of Research, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Benjamin Tan
- Department of Medicine, Washington University, St. Louis, MO, USA
| | - Amaris Tippey
- Siteman Cancer Center, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Manik Amin
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Brolin S, Welin E, Lövström B, Bruchfeld A, Gunnarsson I, Pettersson S. Exploring the educational needs of patients with systemic vasculitis using the educational needs assessment tool. Rheumatol Adv Pract 2022; 6:rkac062. [PMID: 35993015 PMCID: PMC9382267 DOI: 10.1093/rap/rkac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/15/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Knowledge and health literacy enable patients to monitor symptoms and disease impact. Educational needs have previously been explored in rheumatology, but scarcely for patients with ANCA-associated vasculitis (AAV). The aim of the study was to assess the educational needs among patients with AAV using the educational needs assessment tool (ENAT).
Methods
This was a cross-sectional observational study including adults with AAV. Educational needs were captured by ENAT. Total ENAT (0–117 points, with higher numbers indicating higher educational need) and the seven domains (managing pain, movement, feelings, disease process, treatment, self-management and support systems) were explored regarding sex, age, education, diagnosis, disease duration and disease activity. To compare domains, a percentage response (0–100%) was calculated.
Results
One hundred and seventy-eight individuals (50% men; 34% with disease duration ≤2 years) were included. The total ENAT mean was 66.5 (s.d. 26.6; 57%), with domains as follows: disease process, 78%; self-management, 69%; treatments, 64%; feelings, 56%; managing pain, 48%; support systems, 47%; and movement, 41%. Higher educational needs were found among women in the domains movement, feelings and disease process and in total ENAT (all P < 0.04) compared with men. Higher educational needs were also seen in patients with disease duration ≤2 years regarding disease process, self-management and support systems and in total ENAT compared with patients with longer disease duration (all P < 0.03).
Conclusion
This study revealed great educational needs among AAV patients. Some groups expressed higher needs (women and those with shorter disease duration). Increased education for patients with AAV might lead to improved self-care and treatment adherence.
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Affiliation(s)
- Sara Brolin
- Department of Rheumatology, Karolinska University Hospital
- Department of Medicine Solna, Karolinska Institutet, Stockholm
| | | | - Björn Lövström
- Department of Rheumatology, Karolinska University Hospital
- Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping
- Department of Renal Medicine, Karolinska University Hospital
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Iva Gunnarsson
- Department of Rheumatology, Karolinska University Hospital
- Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Susanne Pettersson
- Correspondence to: Susanne Pettersson, Department of Medicine, Solna, Rheumatology Unit, Karolinska Instiutet, 171 77 Stockholm, Sweden. E-mail:
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Corrêa RE, Velho PE, Fornazzaro MF, Tolocka RE. Perceived levels of stress, emotions and physical activity in outpatients with diffuse connective tissue diseases. Ital J Dermatol Venerol 2022; 157:348-354. [PMID: 35373782 DOI: 10.23736/s2784-8671.22.07280-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Diffuse Connective Tissue Diseases (DCTD) are autoimmune diseases that can cause comorbidities, influencing physical and psychological aspects and increase stress. The latter may also be related to the practice of physical activity (PPA). Although evidence shows that it can contribute to patients' health, the level of PPA can decrease after the diagnosis. AIMS to evaluate the basic emotions, perceived stress (PS) and PPA levels of patients with DCTD. METHODS This is a field study. METHODS AND MATERIAL random approach of 55 participants. We used a clinical and sociodemographic profile form, for the verification of emotions, a picture with emojis of the basic emotions, the PSS-14 and the IPAQ-Brief. STATISTICAL ANALYSIS USED dada were analysed with Mann-Whitney U and Kruskal-Wallis tests; with 5% of significance. RESULTS The average age was 49.1 ± 12.9, mostly female (58.7%). High PS was reported by 54.5%; emotions such as joy (38.2%) and anxiety/fear (25.5%], as well as sadness (7.3%), were reported. About 87.3% were classified as having insufficient levels of PPA. Female patients (U=137.0; p<0.05) and insufficient PPA levels (U=86.5%; p<0.05) had higher PS scores, as well as those feeling sadness (X2 =19.0; p<0.05). CONCLUSIONS The results point to the need for care with the emotional domain of these patients and suggest studies that analyze the impact of implementing PPA for this population.
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Affiliation(s)
- Raphaela E Corrêa
- Postgraduate Program in Clinical Medicine, Faculty of Medical Sciences, Universidade Estadual de Campinas - UNICAMP, Campinas, Brazil -
| | - Paulo E Velho
- Department of Dermatology, Faculty of Medical Sciences, Universidade Estadual de Campinas - UNICAMP, Campinas, Brazil
| | - Marielle F Fornazzaro
- Bachelor's Physical Education Course, Universidade Metodista de Piracicaba - UNIMEP, Piracicaba, Brazil
| | - Rute E Tolocka
- Postgraduate Program in Human Movement Sciences, Universidade Metodista de Piracicaba - UNIMEP, Piracicaba, Brazil
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6
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Litchfield I, Greenfield S, Harper L. Addressing the transition to a chronic condition: exploring independent adoption of self-management by patients with ANCA-associated vasculitis. Rheumatol Adv Pract 2021; 5:rkab075. [PMID: 34778700 PMCID: PMC8578693 DOI: 10.1093/rap/rkab075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/05/2021] [Indexed: 11/14/2022] Open
Abstract
Objective Improvements in care have led to the recognition of ANCA-associated vasculitis (AAV) as a chronic condition; however, the self-management strategies considered a crucial component of the care model for patients with more prevalent chronic conditions are yet to be integrated formally into the treatment of AAV patients. The aim of the work we present here is to identify those self-management processes and tasks already being adopted by patients with AAV to help inform existing care and the development of a structured self-management programme. Methods We conducted a series of focus groups and semi-structured interviews with AAV patients, collating the data and performing a post hoc deductive analysis based on a consolidated framework of self-management processes. Results Despite the unique attributes and demands of AAV, patients adopted self-management behaviours previously identified and supported in patients with more prevalent chronic diseases. They accessed information on their disease proactively and learnt to mitigate their symptoms and side-effects. They pursued a range of health-promotion activities and accessed support from their social network and beyond and, ultimately, learnt to integrate the condition into their everyday life. Conclusion Our work has highlighted some key areas of self-management that might be addressed usefully and immediately, including the provision of more consistent information relating to evolving symptoms and side-effects, additional support in accessing both appropriate care and community-based resources, and the use of interventions to bolster resilience. Our findings will inform the development of a tailored self-management programme, but in the meantime provide a more contemporary context for current clinician-patient conversations.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham
| | - Lorraine Harper
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham.,University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
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7
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Harper L, Hewitt CA, Litchfield I, Morgan MD, Chanouzas D, Caulfield HK, Coughlan L, Dean C, Fletcher K, Cramp F, Greenfield S, Ives NJ, Jowett S, Kodabuckus S, Tearne S, Sehmi S, Edwardson C, Dawkins NP, Daley AJ. Management of fatigue with physical activity and behavioural change support in vasculitis: a feasibility study. Rheumatology (Oxford) 2021; 60:4130-4140. [PMID: 33369680 DOI: 10.1093/rheumatology/keaa890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/11/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Patients with ANCA-associated vasculitis (AAV) experience high levels of fatigue, despite disease remission. This study assessed the feasibility and acceptability of a definitive randomized controlled trial of a behavioural-based physical activity intervention to support fatigue self-management in AAV patients. METHODS AAV patients in disease remission with fatigue (Multidimensional Fatigue Inventory-20 general fatigue domain ≥14) were randomly allocated to intervention or standard care in this single-centre open-label randomized controlled feasibility study. The intervention lasted 12 weeks and comprised eight face-to-face physical activity sessions with a facilitator and 12 weekly telephone calls. Participants were encouraged to monitor their physical activity using a tracker device (Fitbit). Standard care involved sign-posting to fatigue websites. The primary outcome was feasibility of a phase III trial assessed against three stop/go traffic light criteria, (recruitment, intervention adherence and study withdrawal). A qualitative study assessed participant views about the intervention. RESULTS A total of 248 patients were screened and 134 were eligible to participate (54%). Stop/go criteria were amber for recruitment; 43/134 (32%, 95% CI: 24, 40) eligible participants randomized, amber for adherence; 73% of participants attended all eight physical activity sessions, but only 11/22 (50%, 95% CI: 29, 71%) completed the intervention as per the intended schedule, and green for study withdrawal; 2/43 participants withdrew before 24 weeks (5%, 95% CI: 0, 11). Qualitative results suggested the intervention was acceptable. CONCLUSION This study suggests a behavioural-based physical activity intervention targeting fatigue self-management was acceptable to patients with AAV, although recruitment and protocol adherence will need modification prior to a definitive trial. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN11929227.
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Affiliation(s)
| | | | | | | | | | - Hollie K Caulfield
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham
| | - Linda Coughlan
- NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | | | - Kate Fletcher
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham
| | - Fiona Cramp
- Faculty of Health and Applied Sciences, University of the West of England, Bristol
| | | | - Natalie J Ives
- Birmingham Clinical Trials Unit, Institute of Applied Health Research
| | | | | | - Sarah Tearne
- Birmingham Clinical Trials Unit, Institute of Applied Health Research
| | - Sukhwant Sehmi
- Birmingham Clinical Trials Unit, Institute of Applied Health Research
| | - Charlotte Edwardson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital
- NHIR Leicester Biomedical Research Centre, Leicester
| | - Nathan P Dawkins
- Diabetes Research Centre, University of Leicester, Leicester General Hospital
- NHIR Leicester Biomedical Research Centre, Leicester
| | - Amanda J Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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8
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Mooney J, Graham K, Watts RA. Impact of caring for someone with a rare rheumatic condition, views from patients and informal carers-the need for cat-like vigilance. Rheumatol Adv Pract 2019; 3:rkz003. [PMID: 31431991 PMCID: PMC6649977 DOI: 10.1093/rap/rkz003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/25/2019] [Indexed: 12/22/2022] Open
Abstract
Objective ANCA-associated vasculitis (AAV) is a rare multisystem disease. Modern therapeutic protocols have turned AAV from an acute, frequently fatal disease into a chronic disease requiring long-term immunosuppression. Patients must often manage substantial burdens related to chronic illness and treatment-related side effects, requiring help from informal carers. This study aimed to explore the experience of patients and of informal carers of patients with AAV about the impact of managing a rare rheumatic condition. Methods A qualitative approach using semi-structured interviews was used. Interviews were conducted with a purposeful sample of 18 pairs of patients with AAV and their informal carers. The interviews were used to explore the participants' experience and effects of caring. The interviews were recorded and transcribed as verbatim text and analysed using the framework technique. Results Eighteen patients (seven female; disease: 10 granulomatosis with polyangiitis; four microscopic polyangiitis; four eosinophilic granulomatosis with polyangiitis; age range 34-78 years; disease duration 1-20 years). Caregiver and patient perspectives were shared. The emerging themes were the physical and psychological impacts of the disease, the need for constant vigilance and fear of the future. Conclusion Both patients and carers faced a range of challenges in managing a rare condition, including the seriousness of the illness, dealing with the emotional toll and knowing what to expect. This study offers insight into the experiences of patients and informal carers, and health-care professionals should address individuals' fears and expectations for recovery.
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Affiliation(s)
- Janice Mooney
- School of Health and Social Care, University of Staffordshire, Stafford, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Karly Graham
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Richard A Watts
- Norwich Medical School, University of East Anglia, Norwich, UK
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Nguyen JT, Roberts C, Thorpe CT, Thorpe JM, Hogan SL, McGregor J, Geryk L, Carpenter DM. Economic and objective burden of caregiving on informal caregivers of patients with systemic vasculitis. Musculoskeletal Care 2019; 17:282-287. [PMID: 30901158 DOI: 10.1002/msc.1394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 01/31/2019] [Accepted: 02/03/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Systemic vasculitis (SV) is associated with substantial economic impact to patients and the healthcare system but little is known about the burden of SV on informal caregivers. We evaluated the objective caregiving burden experienced by informal caregivers of patients with SV. METHODS We surveyed adult patients and their informal caregivers on the physical, emotional, social and economic impacts of SV. We asked patients about the extent to which they felt they were a burden to their identified caregivers. Caregivers reported the direct and indirect economic impact of SV, including employment disturbance, income loss and relative time investment of caregiving for their care recipient's SV. We used the Inventory of Caregiving Activities Questionnaire to compute the objective caregiving burden. RESULTS We analysed data from 68 SV patient-caregiver dyads. Patients reported moderate levels of subjective burden to their caregivers. Over one-quarter of caregivers reported ever having lost some income owing to caregiving for SV. Caregivers reported spending a median of 19 weekly hours on various caregiving tasks, including a median 17 weekly hours on household activities. DISCUSSION Given the extended hours that caregivers spend caring for their care recipient, intervention targets should aim to reduce caregiver burnout in the SV population. Future research should examine the relationship between the objective burden of caregiving for SV and the overall physical health, mental health and quality of life of caregivers.
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Affiliation(s)
- Joehl T Nguyen
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Courtney Roberts
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Carolyn T Thorpe
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
| | - Joshua M Thorpe
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
| | - Susan L Hogan
- UNC Kidney Center and Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
| | - Julie McGregor
- UNC Kidney Center and Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
- Triangle Integrative Medicine Associates, Chapel Hill, North Carolina, United States
| | - Lorie Geryk
- Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland, Oregon, United States
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
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10
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Harper L, Morgan MD, Chanouzas D, Caulfield HK, Coughlan L, Dean C, Fletcher K, Cramp F, Greenfield S, Hewitt CA, Ives NJ, Jowett S, Daley A. Treatment of fatigue with physical activity and behavioural change support in vasculitis: study protocol for an open-label randomised controlled feasibility study. BMJ Open 2018; 8:e023769. [PMID: 30377212 PMCID: PMC6224747 DOI: 10.1136/bmjopen-2018-023769] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Fatigue is a major cause of morbidity, limiting quality of life, in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). The aetiology of fatigue is multifactorial; biological and psychosocial mediators, such as sleep deprivation, pain and anxiety and depression, are important and may be improved by increasing physical activity. Current self-management advice is based on expert opinion and is poorly adhered to. This study aims to investigate the feasibility of increasing physical activity using a programme of direct contact and telephone support, to provide patient education, encourage behaviour self-monitoring and the development of an individual change plan with defined goals and feedback to treat fatigue compared with standard of care to inform the design of a large randomised controlled trial to test the efficacy and cost effectiveness of this programme. METHODS AND ANALYSIS Patients with AAV and significant levels of fatigue (patient self-report using multidimensional fatigue index score questionnaire ≥14) will be randomised in a 1:1 ratio to the physical activity programme supported by behavioural change techniques or standard of care. The intervention programme will consist of 8 visits of supervised activity sessions and 12 telephone support calls over 12 weeks with the aim of increasing physical activity to the level advised by government guidelines. Assessment visits will be performed at baseline, 12, 24 and 52 weeks. The study will assess the feasibility of recruitment, retention, the acceptability, adherence and safety of the intervention, and collect data on various assessment tools to inform the design of a large definitive trial. A nested qualitative study will explore patient experience of the trial through focus groups or interviews. ETHICS AND DISSEMINATION All required ethical and regulatory approvals have been obtained. Findings will be disseminated through conference presentations, patient networks and academic publications. TRIAL REGISTRATION NUMBER ISRCTN11929227.
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Affiliation(s)
- Lorraine Harper
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Matthew David Morgan
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Dimitrios Chanouzas
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Hollie K Caulfield
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Linda Coughlan
- NIHR/Wellcome Trust Clinical Research Facility, UHB NHS Foundation Trust, Birmingham, UK
| | | | - Kate Fletcher
- Institute of Translational Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Fiona Cramp
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Catherine A Hewitt
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Natalie J Ives
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Amanda Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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11
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Thorpe CT, Thorpe JM, Jiang T, Atkinson D, Kang Y, Schleiden LJ, Carpenter DM, McGregor JAG, Hogan SL. Healthcare utilization and expenditures for United States Medicare beneficiaries with systemic vasculitis. Semin Arthritis Rheum 2018; 47:507-519. [PMID: 28918956 PMCID: PMC5743622 DOI: 10.1016/j.semarthrit.2017.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/21/2017] [Accepted: 08/04/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Medicare federal insurance program is the most common United States insurer of patients with systemic vasculitis (SV). We compared healthcare utilization and expenditures for Medicare beneficiaries with versus without SV. METHODS This national, retrospective study used 2010 claims and enrollment data for a 100% cohort of Medicare Part A and B beneficiaries with ≥1 claim including a diagnosis for a form of SV (n = 176,498), and a randomly selected group of non-SV beneficiaries (n = 46,561). Outcomes included annual counts of events in 16 categories of medical services (e.g., inpatient stays, physician visits, tests, and imaging events), and total annual Medicare and patient medical expenditures. We used linear regression with bootstrapped standard errors to compare utilization and expenditures by SV status, before and after matching on age and sex. Prescription drug fills and expenditures for SV (n = 95,157) and non-SV (n = 24,992) beneficiaries with Part D drug benefits were also compared. RESULTS After matching, Medicare spent $11,004 more per patient in 2010 for medical services, and $773 more on prescription drugs, for SV versus non-SV beneficiaries. SV beneficiaries spent $1547 more for medical services and $211 more for prescription drugs. Except for hospice, SV beneficiaries had greater utilization of all services, including two-to-three times more dialysis events, hospital readmissions, inpatient stays, skilled nursing facility stays, and medical tests. CONCLUSIONS The average Medicare beneficiary with SV incurs about double the annual healthcare expenditures compared to their non-SV counterparts, attributable to increased utilization of almost all categories of care.
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Affiliation(s)
- Carolyn T Thorpe
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, 3501 Terrace Street, Pittsburgh, PA 15261; Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA 15240.
| | - Joshua M Thorpe
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, 3501 Terrace Street, Pittsburgh, PA 15261; Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA 15240
| | - Tao Jiang
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, 3501 Terrace Street, Pittsburgh, PA 15261; Division of Geriatric Medicine, University of Pittsburgh School of Medicine, 3471 Fifth Ave., Kaufmann Medical Building, Suite 500, Pittsburgh, PA 15261; First Coast Service Options, Inc., Department of Statistical Medical Data Analysis, 532 Riverside Ave., Jacksonville, FL 32202
| | - Dylan Atkinson
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, 3501 Terrace Street, Pittsburgh, PA 15261
| | - Yihuang Kang
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, 3471 Fifth Ave., Kaufmann Medical Building, Suite 500, Pittsburgh, PA 15261; Department of Information Management, National Sun-Yat-sen University, 70 Lienhai Rd, Kaohsiung 80424, Taiwan
| | - Loren J Schleiden
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, 3501 Terrace Street, Pittsburgh, PA 15261; Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA 15240
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, One University Heights, CPO 2125, Asheville, NC 28804
| | - Julie Anne G McGregor
- UNC Kidney Center and Division of Nephrology & Hypertension, University of North Carolina School of Medicine, 7009 Burnett-Womack, Chapel Hill, NC 27599; Triangle Integrative Medicine Associates, 55 Vilcom Center Dr. #100, Chapel Hill, NC 27514
| | - Susan L Hogan
- UNC Kidney Center and Division of Nephrology & Hypertension, University of North Carolina School of Medicine, 7009 Burnett-Womack, Chapel Hill, NC 27599
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12
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McClean A, Morgan MD, Basu N, Bosch JA, Nightingale P, Jones D, Harper L. Physical Fatigue, Fitness, and Muscle Function in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Arthritis Care Res (Hoboken) 2016; 68:1332-9. [DOI: 10.1002/acr.22827] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/09/2015] [Accepted: 12/15/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew McClean
- Centre for Translational Inflammation Research, University of Birmingham; Birmingham UK
| | - Matthew D. Morgan
- Centre for Translational Inflammation Research, University of Birmingham; Birmingham UK
| | - Neil Basu
- School of Medicine and Dentistry, University of Aberdeen; Aberdeen UK
| | - Jos A. Bosch
- University of Amsterdam; Amsterdam The Netherlands
| | - Peter Nightingale
- NIHR/Wellcome Trust Birmingham Clinical Research Facility, UHB NHS Foundation Trust; Birmingham UK
| | - David Jones
- School of Healthcare Science, Manchester Metropolitan University; Manchester UK
| | - Lorraine Harper
- Centre for Translational Inflammation Research, University of Birmingham; Birmingham UK
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13
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Brown N, Bruce IN, O'Riordan E, Dhaygude A, Helbert M, Caress AL, Sussman JD, Venning MC. Medication-related side effects in vasculitis: a patient self-report survey of awareness and reported uptake of protective therapy. Rheumatology (Oxford) 2016; 55:185-6. [PMID: 26320131 DOI: 10.1093/rheumatology/kev303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nina Brown
- Renal Unit, Manchester Royal Infirmary, Central Manchester Foundation Trust,
| | - Ian N Bruce
- Arthritis Research Epidemiology Unit, University of Manchester, Manchester
| | - Ed O'Riordan
- Renal Unit, Salford Royal Foundation Trust, Salford
| | | | - Matthew Helbert
- Department of Immunology, Central Manchester Foundation Trust
| | - Ann-Louise Caress
- School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester and
| | - Jon D Sussman
- Neurology Unit, Salford Royal Foundation Trust, Salford, UK
| | - Michael C Venning
- Renal Unit, Manchester Royal Infirmary, Central Manchester Foundation Trust
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14
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Novakovich E, Grayson PC. What matters for patients with vasculitis? Presse Med 2015; 44:e267-72. [PMID: 25986940 DOI: 10.1016/j.lpm.2015.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/02/2015] [Indexed: 11/30/2022] Open
Abstract
Advances in clinical care for patients with vasculitis have improved survival rates and created new challenges related to the ongoing management of chronic disease. Lack of curative therapies, burden of disease, treatment-related side effects, and fear of relapse contribute to patient-perceived reduction in quality of life. Patient-held beliefs about disease and priorities may differ substantially from the beliefs of their health care providers, and research paradigms are shifting to reflect more emphasis on understanding vasculitis from the patient's perspective. Efforts are ongoing to develop disease outcome measures in vasculitis that better represent the patient experience. Health care providers who care for patients with vasculitis should be sensitive to the substantial burdens of disease commonly experienced by patients living with the disease and should strive to provide comprehensive care directed towards the medical and biopsychological needs of these patients.
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Affiliation(s)
- Elaine Novakovich
- National Institutes of Health/NIAMS, Vasculitis Translational Research Program, Bethesda, MD 20892, United States
| | - Peter C Grayson
- National Institutes of Health/NIAMS, Vasculitis Translational Research Program, Bethesda, MD 20892, United States.
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15
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Mooney J, Spalding N, Poland F, Grayson P, Leduc R, McAlear CA, Richesson RL, Shereff D, Merkel PA, Watts RA. The informational needs of patients with ANCA-associated vasculitis-development of an informational needs questionnaire. Rheumatology (Oxford) 2014; 53:1414-21. [PMID: 24625507 DOI: 10.1093/rheumatology/keu026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of the study was to compare the informational needs of patients with ANCA-associated vasculitis (AAV). METHODS We developed a Vasculitis Informational Needs Questionnaire that was distributed to members of Vasculitis UK (VUK) by mail and registrants of the Vasculitis Clinical Research Consortium (VCRC) online registry with self-reported AAV. Patients were asked to use a 5-point scale (1 = not important, 5 = extremely important) to rank aspects of information in the following domains: disease, investigations, medication, disease management and psychosocial care. The source and preferred method of educational delivery were recorded. RESULTS There were 314 VUK and 273 VCRC respondents. Respondents rated information on diagnosis, prognosis, investigations, treatment and side effects as extremely important. Information on patient support groups and psychosocial care was less important. There was no difference in the ratings of needs based on group, sex, age, disease duration, disease or method of questionnaire delivery. The most-preferred methods of providing information for both groups were by a doctor (with or without written material) or web based; educational courses and compact disc/digital video disc (CD/DVD) were the least-preferred methods. CONCLUSION This study demonstrates that people with AAV seek specific information concerning their disease, treatment regimes and side effects and the results of investigations. Individuals preferred to receive this information from a doctor. Patients with AAV should be treated in a similar manner to patients with other chronic illnesses in which patient education is a fundamental part of care.
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Affiliation(s)
- Janice Mooney
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Nicola Spalding
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Fiona Poland
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter Grayson
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Renee Leduc
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Carol A McAlear
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Rachel L Richesson
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Denise Shereff
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter A Merkel
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Richard A Watts
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
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16
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Predictors of medication non-adherence for vasculitis patients. Clin Rheumatol 2013; 32:649-57. [PMID: 23314654 DOI: 10.1007/s10067-013-2164-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 12/13/2012] [Accepted: 01/02/2013] [Indexed: 12/14/2022]
Abstract
The primary purpose of this article is to document whether demographic, clinical, regimen-related, intrapersonal, and interpersonal factors predict medication non-adherence for vasculitis patients. A secondary purpose is to explore whether adherence varies by medication type and whether patients experienced drug-related side effects. Vasculitis patients (n = 228) completed online baseline and 3-month follow-up surveys. Demographic (age, gender, education, race, marital status, and insurance status), clinical (perceived vasculitis severity, disease duration, vasculitis type, and relapse/remission status), regimen-related (experience of side effects), intrapersonal (depressive symptoms), and interpersonal (adherence-related support from family and friends) factors were measured at baseline. Medication non-adherence was assessed at follow-up using the Vasculitis Self-Management Survey medication adherence subscale (α = 0.89). Variables that significantly correlated (p < 0.05) with non-adherence were included in a linear regression model to predict non-adherence. Younger age (r = -0.23, p < 0.001), female sex (r = 0.16, p < 0.05), experience of side effects (r = 0.15, p < 0.05), and more depressive symptoms (r = 0.22, p < 0.001) were associated with more medication non-adherence. In the regression model, younger age (β = -0.01, p = 0.01) and more depressive symptoms (β = 0.01 p = 0.02) predicted worse adherence. For six out of eight vasculitis medication types, patients who experienced side effects were less adherent than patients who did not experience side effects. Multiple factors are associated with medication non-adherence for vasculitis patients. Providers should discuss medication adherence and drug-related side effects with vasculitis patients. Providers may want to particularly target younger patients and patients with clinical signs of depression.
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17
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Current World Literature. Curr Opin Rheumatol 2009; 21:85-92. [DOI: 10.1097/bor.0b013e32832355a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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