A Consensus Position Paper From REAL-PANLAR Group About the Methodological Approach for the Accreditation Process of Centers of Excellence in Rheumatoid Arthritis in Latin America:

Better Clinical Results in Rheumatoid Arthritis Patients Treated Under a Multidisciplinary Care Model When Compared with a National Rheumatoid Arthritis Registry

Purpose

To describe clinical characteristics and effectiveness of health care in patients with rheumatoid arthritis (RA) as part of a multidisciplinary care model (MCM) in a specialized rheumatology center, compared with the results of a national registry of RA (NARRA) as evidence of real-world management.

Patients and Methods

We conducted a real-world study (July 1, 2018 to June 30, 2019) based on an analysis of electronic health records of a cohort of RA patients managed with the “Treat-to-Target” strategy in a specialized rheumatology center in Colombia with an MCM, compared with the NARRA that includes different models of usual care.

Results

We have analyzed 7053 subjects with RA treated at a specialized rheumatology center and 81,492 patients from the NARRA. Cohorts were similar in their baseline characteristics, with women in predominance and diagnosis age close to 50 years. At the time of diagnosis, a higher proportion of clinical diagnostic test use and rheumatology consultation access was observed in the specialized rheumatology center than in the national registry (4–6 per year versus three or less). In addition, higher proportions of patients in remission and low disease activity were reported for the specialized rheumatology center, with a >40% amount of data lost in the national registry. Pharmacological management was similar regarding the analgesic use. In the specialized center, Certolizumab was more frequently used than in the NARRA registry; also, there were significant differences in methotrexate, leflunomide, and sulfasalazine use, being higher in the specialized rheumatology center.

Conclusion

The MCM of a specialized center in RA can guarantee comprehensive care, with better access to all the services required to manage the disease. It ensures specialist management and evidence-based care that facilitates the achievement of therapeutic objectives. In addition, better patient records and follow-ups are available to evaluate health outcomes.

Engagement process for patients with spondyloarthritis: PANLAR early SpA clinics project - centers of excellence

Spondyloarthritis (SpA) is one of the most complex rheumatological diseases to diagnose and treat because, in the early stages of the disease, the inflammatory low back pain is often difficult to identify, and patients are diagnosed when they already have advanced structural processes. There is an urgent need to establish healthcare models that allow optimization of the management of these patients. The objective of this work is to propose a care model that is adaptable to the factual realities of Latin America. A systematic search of the literature terms (MeSH) was performed to search associated terms. Taking the model of the REAL-PANLAR project as an example and incorporating some related literature, a model of centers of excellence for SpA in Latin America is proposed that can be reasonably established and implemented. This model proposes 3 types of centers of excellence for SpA according to the level of complexity of each institution, and its criteria are defined based on indicators of structure, processes, and results. This is the first effort in Latin America to try to standardize the care of patients with spondyloarthritis. Key Points • The unmet needs in Latin America in the care of SpondyloArthritis (SpA), demand solutions that facilitate the rapid and assertive access of patients to specialized centers such as Center of Excellence in SpA. • This project facilitates the standardization of high-quality care for patients with SpA, starting from its diagnosis and up to clinical follow-up. • Due to standardization of care, better clinical and safety outcomes are achieved for patients, as well as patient-reported outcomes. • By standardized models of care, will be achieved a reduction in the progress of this pathology and optimization in the use of high-complexity services and high-cost therapies, improving cost-efficiency for public health systems in each country.

Health Disparities in Rheumatic Diseases: Understanding Global Challenges in Africa, Europe, Latin America, and Asia and Proposing Strategies for Improvement

Rheumatic diseases reach across continents with some similarities as well as unique challenges. The intersection between genetic factors, environmental exposures and socioeconomic factors, as well as challenges, with delays in access to subspecialty care and medications, manifest in different ways. By understanding both the challenges and successes in different countries, while also recognizing the significant diversity both within and across continents, unified strategies to improve rheumatic disease outcomes and decrease disparities among the most vulnerable groups can be developed and disseminated.

Clinical Outcomes of Patients with Rheumatoid Arthritis Treated in a Disease Management Program: Real-World Results

Background

Care models can affect the clinical outcome of patients with rheumatic and musculoskeletal diseases.

Objective

We aimed to compare how an innovative model of a rheumatoid arthritis disease-management program can improve the clinical outcomes of patients compared to a conventional assessment approach.

Methods

We performed a retrospective analysis of real-world data from clinical records of a cohort of 5078 patients diagnosed with rheumatoid arthritis who were followed up at the Center of Excellence in Rheumatoid Arthritis vs the clinical outcomes reported in the Colombian National Registry of Rheumatoid Arthritis.

Results

We found significant differences in the diagnosis and follow-up between the specialized Center program and the usual care reported by the Colombian National Registry (p<0.005), including the evaluation of rheumatoid factor, Anti-citrullinated antibodies Disease Activity Score, Health Assessment Questionnaire, number of visits to the rheumatologist, and clinical outcomes measured by the level of disease activity. In addition, when comparing the Center's clinical outcomes - from baseline to the last follow-up, we found an improvement in the level of disease activity, with patients classified in remission increasing from 20.8% to 58.5% (p<0.005), and a reduction in those with high disease activity from 18% to 4.7% (p<0.005).

Conclusion

Real-world evidence showed that patients with rheumatoid arthritis who underwent follow-up under an innovative disease-management model improved their clinical outcomes compared with those patients in a conventional assessment program. These results could suggest a way of improving health policies for patients with rheumatoid arthritis.

Does healthcare regime affiliation influence the clinical outcomes of patients with rheumatoid arthritis?

BACKGROUND/PURPOSE

Adequate control of disease activity in rheumatoid arthritis (RA) depends, to a great extent, on the access to a rheumatologist. This study aimed to compare the disease outcomes of patients with RA, based on their healthcare regime affiliation.

METHODS

A retrospective observational study of Colombian patients with RA in three outpatient services of different regimes: Contributory (CR, workers and their families with a monthly income above a yearly defined threshold, approximately US$ 220, who allocate a percentage of their income to financing the national health fund and to get access to healthcare services), subsidized (SR, a vulnerable population with a monthly income below the threshold, who have access to healthcare through the national health fund; comparable to the USA Medicaid population), and an excellence clinical care center (C3, access to specialized care, regardless of their healthcare affiliation regime). Data were collected from clinical records for 2 years of follow-up and included demographics, lag times between appointments, and time in high disease activity. We used the Mantel-Cox test for the analysis of time to remission/low disease activity.

RESULTS

A total of 240 patients were included (80 patients per regime). At the start of follow-up, mean age was 53.7 years; 21.6% of patients were men; 79.6% of patients had established RA; 72.9% of patients had high disease activity. Patients in the CR had longer lag times between scheduled appointments (p < 0.0001). During follow-up, SR had the highest proportion of patients with high disease activity. Survival curve analysis showed no significant difference between SR and CR groups (p = 0.2903), but was significantly different compared with the C3 group (p < 0.0001). Median survival in high disease activity was greater in the SR group (293 days), followed by CR (254 days), and finally by C3 (64 days).

CONCLUSION

Patients that were treated in the excellence clinical care center had better outcomes when compared with other regimes. These data support that healthcare regime may influence disease outcome in patients with RA. Key Points • Prompt access to healthcare in patients with rheumatoid arthritis is pivotal for an adequate control of the disease, for timely adjustment of treatment, and to reduce both the societal burden of the disease and its impact on individual well-being. • As an example of "structural iatrogenesis," healthcare regime affiliation appears to influence disease outcomes in patients with rheumatoid arthritis, in whom differences between regimes are observed. The most vulnerable patients appear to experience the worst outcomes. • Excellence clinical care centers for patients with rheumatoid arthritis should be implemented as an alternative to counteract structural healthcare barriers and as an approach to improve clinical outcomes through a tighter disease control.