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Contreras DG, McLane P, Barber CEH, Lin K, Elliott MJ, Chomistek K, McQuitty S, Davidson E, Hildebrandt C, Katz S, Lang E, Holroyd BR, Barnabe C. Emergency department utilization by persons with rheumatoid arthritis: a population-based cohort study. Rheumatol Int 2024:10.1007/s00296-024-05627-z. [PMID: 38850323 DOI: 10.1007/s00296-024-05627-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
Some emergency department (ED) visits by persons with rheumatoid arthritis (RA) may be avoidable. This study aims to describe ED use by persons with RA in Alberta, Canada over a 10-year period. Using linked population-based administrative datasets, the annual frequency of ED visits, timing of visits, acuity at presentation assessed (Canadian Triage Acuity Scale (CTAS)), return visits within 72 h, and final disposition were assessed. Most responsible diagnoses assessed by the ED provider were categorized. Between 2008 and 2017, a total of 48,633 persons with RA had 416,964 unique ED visits. There was a 41% relative increase in visits over the study period and within a fiscal year 37% of persons with RA on average attended an ED. Half of the visits were assessed as CTAS 4 'Less Urgent' (31%) and CTAS 5 'Non-Urgent' (19%). No specific diagnosis could be assigned in 36% of visits and RA was listed as the most responsible diagnosis in 2.5% of all visits. Hospital admissions, occurring on average for 14% of ED visits, increased by 15% over the 10 years, and were rare for CTAS 4 (6.4%) and CTAS 5 (1.4%) presentations. Male patients (difference to female 1.2%, 95%CI 0.6, 1.7) and urban patients (difference to rural 8.4%, 95%CI 7.7, 9.2) were more frequently admitted to hospital. Persons with RA have increased ED utilization over time, with a significant volume of less urgent and non-urgent visits. Opportunities for appropriate ambulatory care provision to reduce acute care use should be identified.
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Affiliation(s)
- Dani G Contreras
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Patrick McLane
- Emergency Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Alberta, Edmonton, Canada
| | - Claire E H Barber
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Katie Lin
- Departments of Emergency Medicine and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Meghan J Elliott
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kelsey Chomistek
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Steven Katz
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brian R Holroyd
- Emergency Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Alberta, Edmonton, Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Urruticoechea-Arana A, Sanz J, Ginard D, González-Lama Y, Juanola X, Almirall M, Borruel N, Gratacós J, Loza E. Implementation of the recommendations for the psychological management of patients with spondyloarthritis and inflammatory bowel disease. REUMATOLOGIA CLINICA 2023; 19:423-429. [PMID: 37805255 DOI: 10.1016/j.reumae.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/07/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To assess and improve the level of implementation of the recommendations for the psychological management of patients with spondyloarthritis (SpA) and associated inflammatory bowel disease (IBD). METHODS Qualitative study. We performed a narrative literature review to identify the recommendations for the psychological management of SpA and associated IBD and to explore their level of implementation. Based on the findings, we developed a national survey to assess: (1) current level of knowledge and implementation of the recommendations; (2) attitudes towards the recommendations; and (3) barriers and facilitators to their implementation. The results of the review and survey were discussed by a multidisciplinary group of 9 expert rheumatologists and gastroenterologists, who defined implementation strategies to increase the uptake of the recommendations. RESULTS The review included 4 articles, 2 of them included direct recommendations on the identification and management of psychological problems in patients with SpA and IBD. None assessed the level of implementation of the recommendations in routine clinical practice. Our survey showed a great lack of awareness and implementation of the recommendations, even though psychological issues are very relevant for health professionals. Lack of time, resources, and knowledge are considered the main barriers to adherence to the recommendations. We propose several implementation strategies related to educational activities, clinical practice, and others to increase the uptake of reported recommendations. CONCLUSIONS Further research and efforts are required to achieve behaviour changes in clinical practice to improve the identification and management of psychological problems and needs in patients with SpA and IBD.
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Affiliation(s)
| | - Jesús Sanz
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Daniel Ginard
- Servicio de Gastroenterología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Yago González-Lama
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitario Bellvitge, IDIBELL, Barcelona, Spain
| | - Miriam Almirall
- Servicio de Reumatología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Natalia Borruel
- Unidad de atención Crohn-Colitis (UACC), Servicio del Aparato Digestivo, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Gratacós
- Servicio de Reumatología, Hospital Universitario Parc Taulí Sabadell, I3PT, Departamento de Medicina UAB, Barcelona, Spain
| | - Estíbaliz Loza
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain.
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Seyferth AV, Cichocki MN, Wang CW, Huang YJ, Huang YW, Chen JS, Kuo CF, Chung KC. Factors Associated With Quality Care Among Adults With Rheumatoid Arthritis. JAMA Netw Open 2022; 5:e2246299. [PMID: 36508216 PMCID: PMC9856345 DOI: 10.1001/jamanetworkopen.2022.46299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Although quality care markers exist for patients with rheumatoid arthritis (RA), the predictors of meeting these markers are unclear. OBJECTIVE To explore factors associated with quality care among patients with RA. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using insurance claims from 2009 to 2017 was conducted, and 6 sequential logistic regression models were built to evaluate quality care markers. Quality care markers were measured at 1 year post-RA diagnosis for each patient. The MarketScan Research Database, which contains commercial and Medicare Advantage administrative claims data from more than 100 million individuals in the US, was used to identify patients aged 18 to 64 years with a diagnosis claim for RA. Patients with conditions presenting similar to RA and missing demographic characteristics were excluded. Data analysis occurred between February 18 and May 5, 2022. EXPOSURES Success or failure to meet selected RA quality care markers within 1 year after RA diagnosis. MAIN OUTCOMES AND MEASURES Prevalence of meeting successive quality care markers for RA. RESULTS Among 581 770 patients, 430 843 (74.1%) were women and the mean (SD) age was 48.9 (11.3) years. Most patients (236 285 [40.6%]) resided in the South and had an income less than or equal to $45 200 (490 366 [84.3%]). Of the total study population, 399 862 individuals (68.7%) met at least 1 quality care marker and 181 908 (31.3%) met 0 markers. Most commonly, patients met annual laboratory testing (299 323 [51.5%]) and referral to a rheumatologist (256 765 [44.1%]) markers. The least met marker was receiving hepatitis B screening prior to initiation of disease-modifying antirheumatic drug (DMARD) therapy (18 548 [3.2%]). Women were most likely to meet all quality care markers except receiving DMARDs with hepatitis B screening (odds ratio, 1.14; 95% CI, 1.12-1.16). Individuals with lower median household income had lower odds of receiving a rheumatologist referral, an annual physical examination, or annual laboratory testing, but greater odds of receiving the other quality care markers. Patients with Medicare and those with comorbidities were generally less likely to meet quality care markers. CONCLUSIONS AND RELEVANCE In this cohort study of patients with RA, findings indicated downstream associations with rheumatologist referral and receiving DMARDs and varied associations between meeting quality care markers and patient characteristics. These findings suggest that prioritizing early care, especially for vulnerable patients, will ensure that quality care continues.
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Affiliation(s)
- Anne V. Seyferth
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Meghan N. Cichocki
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Chien-Wei Wang
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Yun-Ju Huang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Wei Huang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Jung-Sheng Chen
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chang-Fu Kuo
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
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Loza E, Carmona L, Woolf A, Fautrel B, Courvoisier DS, Verstappen S, Aarrestad Provan S, Boonen A, Vliet Vlieland T, Marchiori F, Jasinski T, Van der Elst K, Ndosi M, Dziedzic K, Carrasco JM. Implementation of recommendations in rheumatic and musculoskeletal diseases: considerations for development and uptake. Ann Rheum Dis 2022; 81:1344-1347. [PMID: 35961760 DOI: 10.1136/ard-2022-223016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
A clinical guideline is a document with the aim of guiding decisions based on evidence regarding diagnosis, management and treatment in specific areas of healthcare. Specific to rheumatic and musculoskeletal diseases (RMDs), adherence to clinical guidelines recommendations impacts the outcomes of people with these diseases. However, currently, the implementation of recommendations is less than optimal in rheumatology.The WHO has described the implementation of evidence-based recommendations as one of the greatest challenges facing the global health community and has identified the importance of scaling up these recommendations. But closing the evidence-to-practice gap is often complex, time-consuming and difficult. In this context, the implementation science offers a framework to overcome this scenario.This article describes the principles of implementation science to facilitate and optimise the implementation of clinical recommendations in RMDs. Embedding implementation science methods and techniques into recommendation development and daily practice can help maximise the likelihood that implementation is successful in improving the quality of healthcare and healthcare services.
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Affiliation(s)
- Estibaliz Loza
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - Anthony Woolf
- Bone and Joint Research Group, Royal Cornwall Hospital, Truro, UK
| | - Bruno Fautrel
- Rheumatology, Pitie Salpetriere Hospital - Assistance Publique-Hopitaux de Paris, Paris, France.,INSERM UMRS 1136, Sorbonne University, Paris, France
| | | | - Suzanne Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | | | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastrich University Medical Center+, Maastricht, Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Thea Vliet Vlieland
- Orthopaedics, Rehabilitation and Physical Therapy, J11, Leiden University Medical Center, Leiden, Netherlands
| | | | | | | | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK.,Academic Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Krysia Dziedzic
- Impact Accelerator Unit, School of Medicine, Keele University, Newcastle, UK
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