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Zafar SN, Hazlewood G, Dhiman K, Charlton A, Then KL, Dempsey E, Lester R, Hoens AM, Lacaille D, Barnabe C, Rankin J, Mosher D, Barber CEH. "How are you?" Perspectives From Patients and Health Care Providers of Text Messaging to Support Rheumatoid Arthritis Care: A Thematic Analysis. ACR Open Rheumatol 2024; 6:276-286. [PMID: 38376004 DOI: 10.1002/acr2.11652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) may need to access rheumatology care between scheduled visits. WelTel is a virtual care platform that supports secure two-way text-messaging between patients and their health care team. The objective of the present study was to explore perspectives and experiences of health care providers (HCPs) and patients related to the use of WelTel as an adjunct to routine care. METHODS Seventy patients with RA were enrolled in a six-month WelTel pilot project launched in September 2021. Patients received monthly "How are you?" text message check-ins and could message their health care team during clinic hours to request health advice. The current project is a qualitative study of the WelTel pilot. A subgroup of pilot participants was purposively sampled and invited to participate in interviews. A thematic analysis of transcripts was conducted using a deductive approach leveraging quality of care domains. RESULTS Thirteen patients (62% female, mean age 62 years, 10 White) completed interviews. Patients' views suggested that text messaging with the rheumatology team supported high-quality care across multiple quality domains including patient-centeredness, timeliness, efficiency, safety, effectiveness, equity, and appropriateness. Seven HCPs (57.1% female, one pharmacist and six rheumatologists) completed interviews. HCPs' perspectives varied based on their experience with the WelTel platform. Additional themes reported by HCPs included perceived increased workload and burnout. CONCLUSIONS Patients with RA perceived text-based messaging as supporting high-quality care. The impact of increased communications on HCP burnout and workload requires consideration, and future studies should evaluate the effect of texting on patient outcomes.
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Affiliation(s)
- Saania N Zafar
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Glen Hazlewood
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | | | | | - Karen L Then
- Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Erika Dempsey
- Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Richard Lester
- University of British Columbia and WelTel Inc, Vancouver, British Columbia, Canada
| | - Alison M Hoens
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Cheryl Barnabe
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - James Rankin
- University of Calgary, Calgary, Alberta, Canada, and Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Dianne Mosher
- Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Claire E H Barber
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
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Meng CF, Lee YC, Schieir O, Valois MF, Butler MA, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne C, Bessette L, Pope J, Bartlett SJ, Bykerk VP. Having More Tender Than Swollen Joints Is Associated With Worse Patient-Reported Outcomes in Patients With Early RA. J Clin Rheumatol 2024:00124743-990000000-00208. [PMID: 38689390 DOI: 10.1097/rhu.0000000000002091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND/OBJECTIVE In patients with rheumatoid arthritis (RA), high tender-swollen joint differences (TSJDs) have been associated with worse outcomes. A better understanding of the phenotype and impact of high TSJD on patient-reported outcomes (PROs) in early RA may lead to earlier personalized treatment targeting domains that are important to patients today. Our objectives were to evaluate the impact of TSJD on updated PROs in patients with early RA over 1 year and to determine differences in associations by joint size. METHODS This longitudinal cohort study followed patients with active, early RA enrolled in the Canadian Early Arthritis Cohort between 2016 and 2022, who completed clinical assessments and PROMIS-29 measures over 1 year. Twenty-eight joint counts were performed and TSJDs calculated. Adjusted associations between TSJD and PROMIS-29 scores were estimated using separate linear-mixed models. Separate analyses of large versus small-joint TJSDs were performed. RESULTS Patients with early RA (n = 547; 70% female; mean [SD] age, 56 [15] years; mean [SD] symptom duration, 5.3 [2.9] months) were evaluated. A 1-point increase in TSJD was significantly associated with worse PROMIS T-scores in all domains: physical function (adjusted regression coefficient, -0.27; 95% confidence interval [CI], -0.39, -0.15), social participation (adjusted regression coefficient, -0.34; 95% CI, -0.50, -0.19), pain interference (adjusted regression coefficient, 0.49; 95% CI, 0.35, 0.64), sleep problems (adjusted regression coefficient, 0.29; 95% CI, 0.16, 0.43), fatigue (adjusted regression coefficient, 0.34; 95% CI, 0.18, 0.50), anxiety (adjusted regression coefficient, 0.23; 95% CI, 0.08, 0.38), and depression (adjusted regression coefficient, 0.20; 95% CI, 0.06, 0.35). Large-joint TSJD was associated with markedly worse PROs compared with small-joint TSJD. CONCLUSIONS Elevated TSJD is associated with worse PROs particularly pain interference, social participation, and fatigue. Patients with more tender than swollen joints, especially large joints, may benefit from earlier, targeted therapeutic interventions.
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Affiliation(s)
- Charis F Meng
- From the Hospital for Special Surgery, Division of Rheumatology, Weill Cornell Medical College, New York, NY
| | - Yvonne C Lee
- Northwestern University Feinberg School of Medicine, Medicine/Rheumatology, Chicago, Illinois
| | - Orit Schieir
- University of Toronto, Dalla Lana School of Public Health
| | | | - Margaret A Butler
- Hospital for Special Surgery, Division of Rheumatology, New York, NY
| | - Gilles Boire
- Université de Sherbrooke, Medicine, Quebec, Canada
| | - Glen Hazlewood
- University of Calgary, Department of Medicine, Alberta, Canada
| | - Carol Hitchon
- University of Manitoba, Department of Internal Medicine, Winnipeg, Canada
| | | | - Diane Tin
- University of Toronto, Ontario, Canada
| | - Carter Thorne
- Southlake Regional Health Centre, Centre of Arthritis Excellence, TAP Research Group, Ontario, Canada
| | | | - Janet Pope
- University of Western Ontario, London, Ontario, Canada
| | | | - Vivian P Bykerk
- Hospital for Special Surgery and Mount Sinai Hospital, Weill Cornell Medical College, New York, NY
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Subdar S, Hoens AM, White K, Hartfeld NMS, Dhiman K, Duffey K, Heath CE, Lamoureux G, Graveline C, Davidson E, Hazlewood G, Lacaille D, Lopatina E, Barber MRW, Then KL, Crump T, Zafar S, Manske SL, Charlton A, Osinski K, Fifi-Mah A, Mosher D, Barber CEH. An Environmental Scan and Appraisal of Patient Online Resources for Managing Rheumatoid Arthritis Flares. J Rheumatol 2024:jrheum.2023-1025. [PMID: 38490667 DOI: 10.3899/jrheum.2023-1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To conduct an environmental scan and appraisal of online patient resources to support rheumatoid arthritis (RA) flare self-management. METHODS We used the Google search engine (last search March 2023) using the terms "rheumatoid arthritis" and "flare management." Additional searches targeted major arthritis organizations, as well as regional, national, and international resources. Appraisal of the resources was conducted by 2 research team members and 1 patient partner to assess the understandability and actionability of the resource using the Patient Education Materials Assessment Tool (PEMAT). Resources rating ≥ 60% in both domains by either the research team or the patient partner were further considered for content review. During content review, resources were excluded if they contained product advertisements, inaccurate information, or use of noninclusive language. If content review criteria were met, resources were designated as "highly recommended" if both patient partners and researchers' PEMAT ratings were ≥ 60%. If PEMAT ratings were divergent and had a rating ≥ 60% from only 1 group of reviewers, the resource was designated "acceptable." RESULTS We identified 44 resources; 12 were excluded as they did not pass the PEMAT assessment. Fourteen resources received ratings ≥ 60% on understandability and actionability from both researchers and patient partners; 10 of these were retained following content review as "highly recommended" flare resources. Of the 18 divergent PEMAT ratings, 8 resources were retained as "acceptable" following content review. CONCLUSION There is high variability in the actionability and understandability of online RA flare materials; only 23% of resources were highly recommended by researchers and patient partners.
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Affiliation(s)
- Shakeel Subdar
- S. Subdar, HBSc, University of Toronto, Toronto, Ontario
| | - Alison M Hoens
- A.M. Hoens, PT, MSc, Arthritis Research Canada, and Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia
| | - Krista White
- K. White, MA, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Nicole M S Hartfeld
- N.M.S. Hartfeld, MSc, MC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Kiran Dhiman
- K. Dhiman, MPH, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Keeva Duffey
- K. Duffey, MPH, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Claire E Heath
- C.E. Heath, MN, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Gisele Lamoureux
- G. Lamoureux, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Christine Graveline
- C. Graveline, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Eileen Davidson
- E. Davidson, Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia
| | - Glen Hazlewood
- G. Hazlewood, MD, PhD, Arthritis Research Canada, Vancouver, British Columbia, and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Diane Lacaille
- D. Lacaille, MDCM, MHSc, Arthritis Research Canada, and Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Elena Lopatina
- E. Lopatina, MD, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta
| | - Megan R W Barber
- M.R.W. Barber, MD, PhD, Arthritis Research Canada, Vancouver, British Columbia, and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Karen L Then
- K.L. Then, ACNP, PhD, Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Trafford Crump
- T. Crump, PhD, Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec
| | - Saania Zafar
- S. Zafar, BCR, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Sarah L Manske
- S.L. Manske, PhD, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Alexandra Charlton
- A. Charlton, BScPharm, PharmD, Alberta Health Services, Calgary, Alberta
| | - Kelly Osinski
- K. Osinski, RN, BN, Alberta Health Services, Calgary, Alberta
| | - Aurore Fifi-Mah
- A. Fifi-Mah, MD, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Dianne Mosher
- D. Mosher, MD, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Claire E H Barber
- C.E.H. Barber, MD, PhD, Arthritis Research Canada, Vancouver, British Columbia, and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Thomas M, Barnabe C, Kleissen T, Lacaille D, Hazlewood G, Fifi-Mah A, Hassen N, Henry R, Kuluva M, English K, Koehn C, Lane T, Johnson N. Rheumatoid Arthritis Care Experiences of Black People Living in Canada: A Qualitative Study to Inform Health Service Improvements. Arthritis Care Res (Hoboken) 2024; 76:470-485. [PMID: 38073024 DOI: 10.1002/acr.25278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE To understand experiences related to rheumatoid arthritis (RA) care and propose service-level strategies to reduce and mitigate inequities for Black people living in Canada. METHODS Purposive and respondent driven sampling was used to recruit participants for qualitative interviews to explore population factors relevant to RA care and challenges and facilitators for access to health care services, medications, and enacting preferred treatment plans. Thematic analysis was conducted using the Braun and Clarke method with inductive and deductive coding and critical race theory guiding analysis. RESULTS Six women and two men with RA, and two women health care professionals, expressed how their racial identity contributed to their understanding of RA, preferences for treatment, and outcome goals. Health care access was influenced by financial limitations and racism, by exclusion, and discrimination, and also by cultural norms in seeking health care and awareness about RA within the Black community. Participants experienced health system fragmentation and were not connected to ancillary supports. Treatment decision-making was influenced by the legacy of oppression and medical experimentation on Black people and the predominance of biomedical approaches emphasized by health care providers. Holistic and cultural approaches, provided in safe, trauma-informed care environments, with flexibility in service models, are desired. Partnerships between arthritis care services and Black community organizations are proposed to promote community awareness and knowledge about arthritis and provide support mechanisms for patients within their community. CONCLUSION Our study highlights unique considerations based on race and ethnicity and provides suggestions for arthritis care to mitigate inequities for Black people living with arthritis.
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Affiliation(s)
- Megan Thomas
- University of Calgary, Calgary, Alberta, Canada, and The University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Cheryl Barnabe
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | | | - Diane Lacaille
- Arthritis Research Canada and The University of British Columbia, Vancouver, Brtish Columbia, Canada
| | - Glen Hazlewood
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | | | - Nejat Hassen
- Arthritis Research Canada and The University of British Columbia, Vancouver, Brtish Columbia, Canada
| | - Richard Henry
- Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | | | - Kelly English
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Cheryl Koehn
- Arthritis Consumer Experts, Vancouver, British Columbia, Canada
| | - Therese Lane
- Canadian Arthritis Patient Alliance, Ottawa, Ontario, Canada
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Meng CF, Lee Y, Schieir O, Valois MF, Butler M, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne C, Bessette L, Pope J, Bartlett S, Bykerk V. Having More Tender Than Swollen Joints is Associated With Worse Function and Work Impairment in Patients With Early Rheumatoid Arthritis. ACR Open Rheumatol 2024. [PMID: 38446125 DOI: 10.1002/acr2.11658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Patients with early rheumatoid arthritis (RA) may present with more tender than swollen joints, which can persist. Elevated tender-swollen joint difference (TSJD) is often challenging, because there may be multiple causes and it may contribute to overestimating disease activity. Little is known about the phenotype and impact of TSJDs on patient function. Our objective was to evaluate the impact of TSJD on functional outcomes in early RA and to see whether associations vary by joint size. METHODS Data were from patients with active, early RA (≤12 months) enrolled in the Canadian Early Arthritis Cohort, who completed assessments of general function (Multidimensional Health Assessment Questionnaire [MDHAQ]), upper extremity (UE) function (Quality of Life in Neurological Disorders [Neuro-QoL] UE scale), and work/activity impairment (Work Productivity and Activity Impairment RA) over their first year of follow-up. A total of 28 joint counts were performed. TSJDs were calculated. Adjusted associations between TSJDs and functional outcomes were estimated in separate multivariable linear mixed effects models. Separate analyses were performed for large- versus small-joint TSJD. RESULTS Patients (N = 547) were 70% female, mean age 56 (SD 15) years, mean disease duration 5.3 (SD 2.9) months. At baseline, 287 (52%) had TSJD >0 (43% involved large joints and 34% small joints), decreasing to 32% at 12 months. A one-point increase in TSJD was significantly associated with worse function (MDHAQ: adjusted mean change 0.10, 95% confidence interval [CI] 0.08-0.13; Neuro-QoL UE function T score: adjusted mean change -0.59, 95% CI -0.76 to -0.43; and greater work impairment: adjusted mean change 1.95%, 95% CI 0.85%-3.05%). Higher large-joint TSJDs were associated with the worst functional outcomes. CONCLUSION Having more tender than swollen joints is common in early RA and is associated with worse function, most notably when involving large joints. Early identification and targeted intervention strategies may be needed.
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Affiliation(s)
- Charis F Meng
- Hospital for Special Surgery, New York City, New York
| | - Yvonne Lee
- Northwestern University, Chicago, Illinois
| | | | | | | | | | | | | | | | - Diane Tin
- University of Toronto, Ontario, Canada
| | - Carter Thorne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | | | - Janet Pope
- The University of Western Ontario, London, Ontario, Canada
| | | | - Vivian Bykerk
- Hospital for Special Surgery and Mount Sinai Hospital, New York City, New York
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Dhiman K, Hall M, Crump T, Hoens AM, Lacaille D, Rankin JA, Then KL, Hazlewood G, Barnabe C, Katz S, Sutherland J, Dempsey E, Barber CEH. Content validity testing of the INTERMED Self-Assessment in a sample of adults with rheumatoid arthritis and rheumatology healthcare providers. Health Expect 2024; 27:e13978. [PMID: 38366795 PMCID: PMC10873686 DOI: 10.1111/hex.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Care complexity can occur when patients experience health challenges simultaneously with social barriers including food and/or housing insecurity, lack of transportation or other factors that impact care and patient outcomes. People with rheumatoid arthritis (RA) may experience care complexity due to the chronicity of their condition and other biopsychosocial factors. There are few standardised instruments that measure care complexity and none that measure care complexity specifically in people with RA. OBJECTIVES We assessed the content validity of the INTERMEDS Self-Assessment (IMSA) instrument that measures care complexity with a sample of adults with RA and rheumatology healthcare providers (HCPs). Cognitive debriefing interviews utilising a reparative framework were conducted. METHODS Patient participants were recruited through two existing studies where participants agreed to be contacted about future studies. Study information was also shared through email blasts, posters and brochures at rheumatology clinic sites and trusted arthritis websites. Various rheumatology HCPs were recruited through email blasts, and divisional emails and announcements. Interviews were conducted with nine patients living with RA and five rheumatology HCPs. RESULTS Three main reparative themes were identified: (1) Lack of item clarity and standardisation including problems with item phrasing, inconsistency of the items and/or answer sets and noninclusive language; (2) item barrelling, where items asked about more than one issue, but only allowed a single answer choice; and (3) timeframes presented in the item or answer choices were either too long or too short, and did not fit the lived experiences of patients. Items predicting future healthcare needs were difficult to answer due to the episodic and fluctuating nature of RA. CONCLUSIONS Despite international use of the IMSA to measure care complexity, patients with RA and rheumatology HCPs in our setting perceived that it did not have content validity for use in RA and that revision for use in this population under a reparative framework was unfeasible. Future instrument development requires an iterative cognitive debriefing and repair process with the population of interest in the early stages to ensure content validity and comprehension. PATIENT OR PUBLIC CONTRIBUTION Patient and public contributions included both patient partners on the study team and people with RA who participated in the study. Patient partners were involved in study design, analysis and interpretation of the findings and manuscript preparation. Data analysis was structured according to emergent themes of the data that were grounded in patient perspectives and experiences.
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Affiliation(s)
- Kiran Dhiman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marc Hall
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Trafford Crump
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alison M Hoens
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - James A Rankin
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Karen L Then
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
| | - Steven Katz
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jason Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erika Dempsey
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
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7
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Subdar S, Dhiman K, Hartfeld NMS, Hoens AM, White K, Manske SL, Hazlewood G, Lacaille D, Lopatina E, Barber MRW, Mosher D, Fifi-Mah A, Twilt M, Luca N, Then KL, Crump T, Zafar S, Osinski K, Barber CEH. Investigating the influence of patient eligibility characteristics on the number of deferrable rheumatologist visits: planning for a patient-initiated follow-up (PIFU) strategy. J Rheumatol 2024:jrheum.2023-0891. [PMID: 38302163 DOI: 10.3899/jrheum.2023-0891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Patient-initiated follow-up (PIFU) for rheumatoid arthritis (RA) is a model of care delivery wherein patients contact the clinic when needed instead of regularly scheduled followups. Our objective was to investigate the influence of different patient eligibility characteristics on the number of potentially deferred visits to inform future implementation of a PIFU strategy. METHODS We conducted a retrospective chart review of seven rheumatologists' practices at two university-based clinics between 01/03/2021-28/02/2022. Data extracted included the type and frequency of visits, disease management, comorbidities, and care complexities. Stable disease was defined as remission or low-disease activity with no medication changes at all visits. The influence of patient characteristics on the number of deferrable visits in patients with stable disease was explored in four criteria sets that were based on: early disease duration, medication prescribed, presence of care complexity elements, and comorbidity burden. RESULTS Records from 770 visits were reviewed from 365 RA patients (71.5% female, 70.0% seropositive). Among all criteria sets, the proportion of visits that could be redirected varied between 2.5%-20.9%. The highest proportion of deferrable visits was achieved when eligibility criteria included only stable disease activity and RA patients on conventional synthetic disease modifying drugs or no medications (n=161, 20.9%). CONCLUSION PIFU may result in a more efficient use of specialist healthcare resources. However, the applicability of such models of care and the number of deferred visits is highly dependent on patient characteristics used to establish eligibility criteria for that model. These findings should be considered when planning implementation trials.
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Affiliation(s)
- Shakeel Subdar
- Shakeel Subdar HBSc, University of Toronto, Toronto, Ontario, Canada
| | - Kiran Dhiman
- Kiran Dhiman MPH, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole M S Hartfeld
- Nicole M.S. Hartfeld MSc MC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alison M Hoens
- Alison M. Hoens PT MSc, Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Krista White
- Krista White MA, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah L Manske
- Sarah L. Manske PhD, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Glen Hazlewood
- Glen Hazlewood MD PhD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,, Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lacaille
- Diane Lacaille MDCM MHSc FRCPC, Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Elena Lopatina
- Elena Lopatina MD PhD, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Megan R W Barber
- Megan R.W. Barber MD PhD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Mosher
- Dianne Mosher MD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aurore Fifi-Mah
- Aurore Fifi-Mah MD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marinka Twilt
- Marinka Twilt MD MSCE PhD, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nadia Luca
- Nadia Luca MD FRCPC MSc, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen L Then
- Karen L. Then ACNP PhD, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Trafford Crump
- Trafford Crump PhD, Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Saania Zafar
- Saania Zafar BCR, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly Osinski
- Kelly Osinski, Alberta Health Services, Calgary, Alberta, Canada
| | - Claire E H Barber
- Claire E.H. Barber MD PhD FRCPC, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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8
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Dewidar O, Bondok M, Abdelrazeq L, Aliyeva K, Solo K, Welch V, Brignardello-Petersen R, Mathew JL, Hazlewood G, Pottie K, Hartling L, Khalifa DS, Duda S, Falavigna M, Khabsa J, Lotfi T, Petkovic J, Elliot S, Chi Y, Parker R, Kristjansson E, Riddle A, Darzi AJ, Magwood O, Saad A, Rada G, Neumann I, Loeb M, Reveiz L, Mertz D, Piggott T, Turgeon AF, Schünemann H, Tugwell P. Equity issues rarely addressed in the development of COVID-19 formal recommendations and good practice statements: a cross-sectional study. J Clin Epidemiol 2023; 161:116-126. [PMID: 37562727 DOI: 10.1016/j.jclinepi.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/21/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND OBJECTIVE To identify COVID-19 actionable statements (e.g., recommendations) focused on specific disadvantaged populations in the living map of COVID-19 recommendations (eCOVIDRecMap) and describe how health equity was assessed in the development of the formal recommendations. METHODS We employed the place of residence, race or ethnicity or culture, occupation, gender or sex, religion, education, socio-economic status, and social capital-Plus framework to identify statements focused on specific disadvantaged populations. We assessed health equity considerations in the evidence to decision frameworks (EtD) of formal recommendations for certainty of evidence and impact on health equity criteria according to the Grading of Recommendations, Assessment, Development, and Evaluations criteria. RESULTS We identified 16% (124/758) formal recommendations and 24% (186/819) good practice statements (GPS) that were focused on specific disadvantaged populations. Formal recommendations (40%, 50/124) and GPS (25%, 47/186) most frequently focused on children. Seventy-six percent (94/124) of the recommendations were accompanied with EtDs. Over half (55%, 52/94) of those considered indirectness of the evidence for disadvantaged populations. Considerations in impact on health equity criterion most frequently involved implementation of the recommendation for disadvantaged populations (17%, 16/94). CONCLUSION Equity issues were rarely explicitly considered in the development COVID-19 formal recommendations focused on specific disadvantaged populations. Guidance is needed to support the consideration of health equity in guideline development during health emergencies.
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Affiliation(s)
- Omar Dewidar
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
| | - Mostafa Bondok
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leenah Abdelrazeq
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Khadija Aliyeva
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Karla Solo
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Romina Brignardello-Petersen
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Joseph L Mathew
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Glen Hazlewood
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kevin Pottie
- Department of Family Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence and Cochrane Child Health, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Dina Sami Khalifa
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Duda
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maicon Falavigna
- National Institute for Health Technology Assessment, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tamara Lotfi
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Petkovic
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Elliot
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Cochrane Child Health, Department of Pediatrics, University of Alberta, Alberta, Canada
| | - Yuan Chi
- Beijing Yealth Technology Co., Ltd, Beijing, China; Cochrane Campbell Global Ageing Partnership, London, UK
| | | | - Elizabeth Kristjansson
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Riddle
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea J Darzi
- Department of Health Research Methods, Evidence, and Impact and Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Olivia Magwood
- Bruyère Research Institute, Ottawa, Ontario, Canada; Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, Canada
| | - Ammar Saad
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Gabriel Rada
- Epistemonikos Foundation, Santiago, Chile; UC Evidence Centre, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Neumann
- School of Medicine, Universidad San Sebastián, Santiago, Chile
| | - Mark Loeb
- Departments of Pathology and Molecular Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ludovic Reveiz
- Department of Evidence and Intelligence for Action in Health and Incident Management System for COVID-19, WHO Regional Office for the Americas/Pan American Health Organization, Washington, DC, USA
| | - Dominik Mertz
- Department of Medicine and Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Family Medicine, Queens University, Kingston, Ontario, Canada; Peterborough Public Health, Peterborough, Ontario, Canada
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Québec City, Quebec, Canada; Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Quebec, Canada
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences Humanitas University, Humanitas University, Milan, Italy; Cochrane Canada, Hamilton, Ontario, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Tugwell P, Welch V, Magwood O, Todhunter-Brown A, Akl EA, Concannon TW, Khabsa J, Morley R, Schunemann H, Lytvyn L, Agarwal A, Antequera A, Avey MT, Campbell P, Chang C, Chang S, Dans L, Dewidar O, Ghersi D, Graham ID, Hazlewood G, Hilgart J, Horsley T, John D, Jull J, Maxwell LJ, McCutcheon C, Munn Z, Nonino F, Pardo Pardo J, Parker R, Pottie K, Rada G, Riddle A, Synnot A, Ghogomu ET, Tomlinson E, Toupin-April K, Petkovic J. Protocol for the development of guidance for collaborator and partner engagement in health care evidence syntheses. Syst Rev 2023; 12:134. [PMID: 37533051 PMCID: PMC10394942 DOI: 10.1186/s13643-023-02279-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/18/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Involving collaborators and partners in research may increase relevance and uptake, while reducing health and social inequities. Collaborators and partners include people and groups interested in health research: health care providers, patients and caregivers, payers of health research, payers of health services, publishers, policymakers, researchers, product makers, program managers, and the public. Evidence syntheses inform decisions about health care services, treatments, and practice, which ultimately affect health outcomes. Our objectives are to: A. Identify, map, and synthesize qualitative and quantitative findings related to engagement in evidence syntheses B. Explore how engagement in evidence synthesis promotes health equity C. Develop equity-oriented guidance on methods for conducting, evaluating, and reporting engagement in evidence syntheses METHODS: Our diverse, international team will develop guidance for engagement with collaborators and partners throughout multiple sequential steps using an integrated knowledge translation approach: 1. Reviews. We will co-produce 1 scoping review, 3 systematic reviews and 1 evidence map focusing on (a) methods, (b) barriers and facilitators, (c) conflict of interest considerations, (d) impacts, and (e) equity considerations of engagement in evidence synthesis. 2. Methods study, interviews, and survey. We will contextualise the findings of step 1 by assessing a sample of evidence syntheses reporting on engagement with collaborators and partners and through conducting interviews with collaborators and partners who have been involved in producing evidence syntheses. We will use these findings to develop draft guidance checklists and will assess agreement with each item through an international survey. 3. CONSENSUS The guidance checklists will be co-produced and finalised at a consensus meeting with collaborators and partners. 4. DISSEMINATION We will develop a dissemination plan with our collaborators and partners and work collaboratively to improve adoption of our guidance by key organizations. CONCLUSION Our international team will develop guidance for collaborator and partner engagement in health care evidence syntheses. Incorporating partnership values and expectations may result in better uptake, potentially reducing health inequities.
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Affiliation(s)
- Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Canada
| | - Vivian Welch
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Bruyere Research Institute, Ottawa, Canada
| | - Olivia Magwood
- Bruyere Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Alex Todhunter-Brown
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Thomas W Concannon
- The RAND Corporation and Tufts University School of Medicine, Boston, MA, USA
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Holger Schunemann
- Department of Health Research Methods, Evidence, and Impact, Michael G DeGroote Cochrane Canada Centre, Cochrane Canada and McMaster GRADE Centre, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Cochrane Canada, Hamilton, ON, Canada
| | | | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alba Antequera
- International Health Department, ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Marc T Avey
- Canadian Council On Animal Care, Ottawa, Canada
| | - Pauline Campbell
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Christine Chang
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | | | - Leonila Dans
- Department of Clinical Epidemiology, University of the Philippines-Manila, Manila, Philippines
| | | | - Davina Ghersi
- Research Translation, National Health and Medical Research Council, Canberra, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Ian D Graham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Glen Hazlewood
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Tanya Horsley
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Denny John
- PharmaQuant, Kolkata, India
- Center for Public Health Research (CPHR), Kolkata, India
| | - Janet Jull
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Chris McCutcheon
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Zachary Munn
- Faculty of Health and Medical Sciences, JBI, University of Adelaide, Adelaide, South Australia, Australia
| | - Francesco Nonino
- Unit of Epidemiology and Statistics, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Jordi Pardo Pardo
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa Methods Centre, Ottawa, Canada
| | - Roses Parker
- Cochrane Pain Palliative and Supportive Care, Oxford University Hospitals Trust, Oxford, England
| | - Kevin Pottie
- Departments of Family Medicine and Epidemiology and Biostatistics, Western University, London, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Gabriel Rada
- Epistemonikos Foundation, Santiago, Chile
- UC Evidence Centre and Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alison Riddle
- Bruyere Research Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Anneliese Synnot
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne Victoria, 3004, Australia
- Centre for Health Communication and Participation, School of Public Health and Psychological Sciences, La Trobe University, Plenty Rd, Bundoora, VIC, 3086, Australia
| | - Elizabeth Tanjong Ghogomu
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Bruyere Research Institute, Ottawa, Canada
| | - Eve Tomlinson
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Institut du Savoir Montfort, Ottawa, Canada
| | - Jennifer Petkovic
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
- Bruyere Research Institute, Ottawa, Canada.
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10
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Wang H, Dewidar O, Whittle SL, Ghogomu E, Hazlewood G, Leder K, Mbuagbaw L, Pardo Pardo J, Robinson PC, Buchbinder R, Welch V. Equity Considerations in COVID-19 Vaccination Studies of Individuals With Autoimmune Inflammatory Rheumatic Diseases. Arthritis Care Res (Hoboken) 2023; 75:967-974. [PMID: 36194078 PMCID: PMC9874440 DOI: 10.1002/acr.25034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/23/2022] [Accepted: 09/29/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE We sought to examine the extent to which populations experiencing inequities were considered in studies of COVID-19 vaccination in individuals with autoimmune inflammatory rheumatic diseases (AIRDs). METHODS We included all studies (n = 19) from an ongoing Cochrane living systematic review on COVID-19 vaccination in patients with AIRDs. We used the PROGRESS-Plus framework (place of residence, race/ethnicity, occupation, gender/sex, religion, education, socioeconomic status, and social capital, plus: age, multimorbidity, and health literacy) to identify factors that stratify health outcomes. We assessed equity considerations in relation to differences in COVID-19 baseline risk, eligibility criteria, and description of participant characteristics and attrition, controlling for confounding factors, subgroup analyses, and applicability of findings. RESULTS All 19 studies were cohort studies that followed individuals with AIRDs after vaccination. Three studies (16%) described differences in baseline risk for COVID-19 across age. Two studies (11%) defined eligibility criteria based on occupation and age. All 19 studies described participant age and sex. Twelve studies (67%) controlled for age and/or sex as confounders. Eight studies (47%) conducted subgroup analyses across at least 1 PROGRESS-Plus factor, most commonly age. Ten studies (53%) interpreted applicability in relation to at least 1 PROGRESS-Plus factor, most commonly age (47%), then ethnicity (16%), sex (16%), and multimorbidity (11%). CONCLUSION Sex and age were the most frequently considered PROGRESS-Plus factors in studies of COVID-19 vaccination in individuals with AIRDs. The generalizability of evidence to populations experiencing inequities is uncertain. Future COVID-19 vaccine studies should report participant characteristics in more detail to inform guideline recommendations.
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Affiliation(s)
- Harry Wang
- University of Ottawa and Bruyère Research InstituteOttawaOntarioCanada
| | | | - Samuel L. Whittle
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia, and Monash UniversityMelbourneVictoriaAustralia
| | | | | | | | | | | | - Philip C. Robinson
- University of Queensland School of Medicine and Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
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11
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Bhangu G, Hartfeld NMS, Lacaille D, Lopatina E, Hoens AM, Barber MRW, Then KL, Zafar S, Fifi-Mah A, Hazlewood G, Barber CEH. A scoping review of shared care models for rheumatoid arthritis with patient-initiated follow-up. Semin Arthritis Rheum 2023; 60:152190. [PMID: 36934470 DOI: 10.1016/j.semarthrit.2023.152190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE An emerging strategy to address access challenges to rheumatologists for patients with RA is shared care between primary and specialist care, with patient-initiated rheumatologist follow-up as needed. The objective of this scoping review was to explore studies implementing this model of care. METHODS Four electronic databases were searched from 01/01/2000-31/03/2022 using three main concepts (RA, shared care, patient-initiated follow-up). English-language studies of any design were included if they described the implementation and/or outcomes of shared care model for RA with patient-initiated follow-up. Two authors reviewed and selected articles in duplicate and extracted data on study characteristics, care model implementation and outcomes according to a pre-specified protocol. RESULTS Following duplicate removal, 1578 articles were screened for inclusion and 58 underwent full-text review. Sixteen articles were included, representing 10 unique studies. Five studies had qualitative outcomes and two were pre-implementation studies. Model implementation varied significantly between studies. Effectiveness data was available in 10 studies and demonstrated equivalent outcomes for the model of care (disease activity, radiographic damage, quality of life). Health system costs were equivalent or lower than usual care. While satisfaction with care was equivalent or improved in shared care models with patient-initiated follow-up, some concerns were expressed in qualitative evaluation around appropriate patient selection for such models, and information for health equity evaluation was not reported. CONCLUSIONS While shared care models with patient-initiated follow-up may offer comparable outcomes for RA, further work is required to understand patient preferences, health equity considerations and longer-term outcomes for such models of care.
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Affiliation(s)
- Gurjeet Bhangu
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole M S Hartfeld
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Canada; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elena Lopatina
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alison M Hoens
- Arthritis Research Canada, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Megan R W Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Canada
| | - Karen L Then
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Saania Zafar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Canada
| | - Aurore Fifi-Mah
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Canada
| | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Arthritis Research Canada, Canada.
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12
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Barber CEH, Lacaille D, Croxford R, Barnabe C, Marshall DA, Abrahamowicz M, Xie H, Avina-Zubieta JA, Esdaile JM, Hazlewood G, Faris P, Katz S, MacMullan P, Mosher D, Widdifield J. System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002-2019. BMC Rheumatol 2022; 6:86. [PMID: 36572934 PMCID: PMC9793576 DOI: 10.1186/s41927-022-00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/25/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To determine whether there were improvements in rheumatology care for rheumatoid arthritis (RA) between 2002 and 2019 in Ontario, Canada, and to evaluate the impact of rheumatologist regional supply on access. METHODS We conducted a population-based retrospective study of all individuals diagnosed with RA between January 1, 2002 and December 31, 2019. Performance measures evaluated were: (i) percentage of RA patients seen by a rheumatologist within one year of diagnosis; and (ii) percentage of individuals with RA aged 66 years and older (whose prescription drugs are publicly funded) dispensed a disease modifying anti-rheumatic drug (DMARD) within 30 days after initial rheumatologist visit. Logistic regression was used to assess whether performance improved over time and whether the improvements differed by rheumatology supply, dichotomized as < 1 rheumatologist per 75,000 adults versus ≥1 per 75,000. RESULTS Among 112,494 incident RA patients, 84% saw a rheumatologist within one year: The percentage increased over time (adjusted odds ratio (OR) 2019 vs. 2002 = 1.43, p < 0.0001) and was consistently higher in regions with higher rheumatologist supply (OR = 1.73, 95% CI 1.67-1.80). Among seniors who were seen by a rheumatologist within 1 year of their diagnosis the likelihood of timely DMARD treatment was lower among individuals residing in regions with higher rheumatologist supply (OR = 0.90 95% CI 0.83-0.97). These trends persisted after adjusting for other covariates. CONCLUSION While access to rheumatologists and treatment improved over time, shortcomings remain, particularly for DMARD use. Patients residing in regions with higher rheumatology supply were more likely to access care but less likely to receive timely treatment.
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Affiliation(s)
- Claire E. H. Barber
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Ruth Croxford
- grid.418647.80000 0000 8849 1617ICES, Toronto, Canada
| | - Cheryl Barnabe
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Deborah A. Marshall
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Michal Abrahamowicz
- Arthritis Research Canada, Vancouver, BC Canada ,grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, McGill University, Montreal, QC Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, BC Canada ,grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - J. Antonio Avina-Zubieta
- Arthritis Research Canada, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - John M. Esdaile
- Arthritis Research Canada, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Glen Hazlewood
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Peter Faris
- grid.413574.00000 0001 0693 8815Alberta Health Services, Calgary, AB Canada
| | - Steven Katz
- grid.17089.370000 0001 2190 316XDepartment of Medicine, University of Alberta, Edmonton, AB Canada
| | - Paul MacMullan
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada
| | - Dianne Mosher
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada
| | - Jessica Widdifield
- grid.418647.80000 0000 8849 1617ICES, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Canada
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Choudhary D, Thomas M, Pacheco-Barrios K, Zhang Y, Alonso-Coello P, Schünemann H, Hazlewood G. Methods to Summarize Discrete-Choice Experiments in a Systematic Review: A Scoping Review. Patient 2022; 15:629-639. [PMID: 35829927 DOI: 10.1007/s40271-022-00587-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Systematic reviews of discrete-choice experiments (DCEs) are being increasingly conducted. The objective of this scoping review was to identify and describe the methodologies that have been used to summarize results across DCEs. METHODS We searched the electronic databases MEDLINE and EMBASE from inception to March 18, 2021, to identify English-language systematic reviews of patient preferences that included at least two DCEs and extracted data on attribute importance. The methods used to summarize results across DCEs were classified into narrative, semi-quantitative, and quantitative (meta-analytic) approaches and compared. Approaches to characterize the extent of preference heterogeneity were also described. RESULTS From 7362 unique records, we identified 54 eligible reviews from 2010 to Mar 2021, across a broad range of health conditions. Most (83%) used a narrative approach to summarize findings of DCEs, often citing differences in studies as the reason for not formally pooling findings. Semi-quantitative approaches included summarizing the frequency of the most important attributes, the frequency of attribute statistical significance, or tabulated comparisons of attribute importance for each pair of attributes. One review conducted a meta-analysis using the maximum acceptable risk. While reviews often commented on the heterogeneity of patient preferences, few (6%) addressed this systematically across studies. CONCLUSION While not commonly used, several semi-quantitative and one quantitative approach for synthesizing results of DCEs were identified, which may be useful for generating summary estimates across DCEs when appropriate. Further work is needed to assess the validity and usefulness of these approaches.
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Affiliation(s)
- Daksh Choudhary
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Megan Thomas
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Sintesis de Evidencias en Salud, Lima, Peru
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Instituto de Investigación Biomédica (IIB Sant Pau), Centro Cochrane Iberoamericano, Barcelona, Spain
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Glen Hazlewood
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Bartlett SJ, Bykerk VP, Schieir O, Valois MF, Pope JE, Boire G, Hitchon C, Hazlewood G, Bessette L, Keystone E, Thorne C, Tin D, Bingham CO. "From Where I Stand": using multiple anchors yields different benchmarks for meaningful improvement and worsening in the rheumatoid arthritis flare questionnaire (RA-FQ). Qual Life Res 2022; 32:1307-1318. [PMID: 36074252 DOI: 10.1007/s11136-022-03227-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The Rheumatoid Arthritis Flare Questionnaire (RA-FQ) is a patient-reported measure of disease activity in RA. We estimated minimal and meaningful change from the perspective of RA patients, physicians, and using a disease activity index. METHODS Data were from 3- to 6-month visits of adults with early RA enrolled in the Canadian Early Arthritis Cohort. Participants completed the RA-FQ, the Patient Global Assessment of RA, and the Patient Global Change Impression at consecutive visits. Rheumatologists recorded joint counts and MD Global. Clinical Disease Activity Index (CDAI) scores were computed. We compared mean RA-FQ change across categories using patients, physicians, and CDAI anchors. RESULTS The 808 adults were mostly white (84%) women (71%) with a mean age of 55 and moderate-high disease activity (85%) at enrollment. At V2, 79% of patients classified their RA as changed; 59% were better and 20% were worse. Patients reporting they were a lot worse had a mean RA-FQ increase of 8.9 points, whereas those who were a lot better had a -6.0 decrease. Minimal worsening and improvement were associated with a mean 4.7 and - 1.8 change in RA-FQ, respectively, while patients rating their RA unchanged had stable scores. Physician and CDAI classified more patients as worse than patients, and minimal and meaningful RA-FQ thresholds differed by group. CONCLUSION Thresholds to identify meaningful change vary by anchor used. These data offer new evidence demonstrating robust psychometric properties of the RA-FQ and offer guidance about improvement or worsening, supporting its use in RA care, research, and decision-making.
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Affiliation(s)
- Susan J Bartlett
- Centre for Outcomes Research and Evaluation, McGill University, 5252 de Maisonneuve, #3D.57, Montreal, QC, H4A 3S5, Canada. .,Research Institute, McGill University Health Center, Montreal, QC, Canada. .,Arthritis Research Canada, Vancouver, Canada.
| | - Vivian P Bykerk
- Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Orit Schieir
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Marie-France Valois
- Centre for Outcomes Research and Evaluation, McGill University, 5252 de Maisonneuve, #3D.57, Montreal, QC, H4A 3S5, Canada
| | - Janet E Pope
- St. Joseph's Health Care London, University of Western Ontario, London, ON, Canada
| | - Gilles Boire
- University of Sherbrooke, Sherbrooke, QC, Canada
| | | | - Glen Hazlewood
- Arthritis Research Canada, Vancouver, Canada.,University of Calgary, Calgary, AB, Canada
| | | | | | | | - Diane Tin
- The Arthritis Center, Newmarket, ON, Canada
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Bartlett SJ, Schieir O, Valois MF, Tin D, Keystone E, Bessette L, Pope J, Boire G, Hazlewood G, Hitchon C, Thorne C, Bykerk V. AB1180 COVID-19 HAD DISPROPORTIONATE IMPACTS ON RA SYMPTOMS AND FUNCTION BY SEX AND AGE: RESULTS FROM THE CANADIAN EARLY ARTHRITIS COHORT (CATCH). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundDuring the COVID-19 pandemic, Canadians with RA faced considerable uncertainty due to greater risk of infection, hospitalization, changing access to RA medications, and very limited access to in-person RA care. Further, to reduce transmission of the virus and COVID-related hospitalizations, stringent mitigation measures were implemented across the country to greatly reduce social contacts including curfews, limits on private gatherings and business closures. Little is known about the impact of the COVID-19 pandemic and associated mitigation efforts in RA. We hypothesized that women and younger adults with RA would report greater impairments in HRQL.ObjectivesTo compare changes in HRQL prior-to and during the COVID-19 pandemic by sex and age groups in real-world RA patients seen in routine practice settings.MethodsData were from patients in the Canadian Early Arthritis Cohort (CATCH) who completed a study visit in the year prior to the COVID-19 pandemic (Mar 2019 through Feb 2020) and a repeat assessment during the pandemic period (Mar 2020 – Jan 2022). RA disease activity was assessed using the RA Flare Questionnaire, a validated patient-reported measure of current RA disease symptoms (pain, stiffness, fatigue) and function (physical, participation). An RA-FQ score ≥ 20 was used to classify RA symptoms consistent with an RA inflammatory flare. HRQL was assessed using PROMIS-29 Adult Profiles. We compared changes in mean Physical (PHS) and Mental Health (MHS) scores, and the proportion of patients with impairments in each domain (i.e., scores ≥ 55 for pain interference, fatigue, anxiety, depression, and sleep and ≤45 for physical function and participation) before and during the COVID-19 pandemic across sex and age groups (<40, 40-64, ≥65 years).ResultsThe 938 CATCH participants in the analytic sample with data available at both time periods had a mean (SD) age of 60 (13) and RA symptom duration of 5.8 (3.7) years; 72% were women, 88% were white, and 64% reported >high school education. Most (80%) were in CDAI REM/LDA at the most recent visit prior to start of pandemic. The proportion of patients with RA-FQ ≥20 were similar at both time periods. While physical and emotional RA symptom impacts remained stable in men prior to and during the COVID-19 pandemic, women reported significant increases in anxiety and depression during the pandemic period. Younger RA patients <40 reported increases in depression, and older RA patients (65+) reported increases in anxiety and greater impacts on participation.ConclusionOur results illustrate that while the proportions of patients with high inflammatory disease activity were similar prior to and during the COVID-19 pandemic, we observed disproportionate impacts on HRQL by sex and age with a higher proportion of women, adults <40, and those ≥65 years of age experiencing greater impairments in several HRQL domains.Table 1.DomainWomen (N = 673)Men (N=265)Age <40 (N=84)Age 45-64 (N=492)Age 65+ (N= 362)BeforeDuringBeforeDuringBeforeDuringBeforeDuringBeforeDuringRA Flare >20%17%21%19%18%13%7%18%21%18%21%Anxiety34%*42%*23%23%42%55%32%35%28%*35%*Depression28%*34%*22%20%25%*42%*28%28%24%30%Fatigue36%38%24%23%43%43%36%33%26%32%Pain47%52%48%45%39%48%46%49%49%54%Physical function54%57%46%46%40%40%49%50%59%62%Participation42%47%34%36%37%38%40%41%40%*49%*Sleep30%34%18%22%26%29%29%33%23%28%*p <0.05AcknowledgementsCATCH is supported through unrestricted research grants from: Amgen and Pfizer Canada since 2007; AbbVie since 2011; Medexus since 2013; Sandoz Canada since 2019; Fresenius Kabi Canada since 2021 and; Organon Canada since 2021. Previous funding from Janssen Canada (2011-16); UCB Canada and Bristol-Myers Squibb Canada (2011-18); Hoffman La Roche (2011-21); Sanofi Genzyme (2016-17); Eli Lilly Canada (2016-20); Merck Canada (2017-21) and Gilead Sciences Canada (2020-21)Disclosure of InterestsNone declared
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Wang H, Dewidar O, Whittle S, Ghogomu E, Hazlewood G, Mbuagbaw L, Pardo Pardo J, Robinson P, Buchbinder R, Welch V. POS1208 EQUITY CONSIDERATIONS IN COVID-19 VACCINATION STUDIES OF INDIVIDUALS WITH AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIndividuals with autoimmune inflammatory rheumatic diseases (AIRDs) have an increased baseline risk of severe COVID-19 infection. Intersection of inequity factors may result in more severe adverse effects through influencing opportunities for health. We sought to examine the extent to which populations experiencing inequities were considered in studies of COVID-19 vaccination in individuals with AIRDs.ObjectivesThe objective of this study is to assess how health equity is considered in studies of COVID-19 vaccination studies in individuals with AIRDs.MethodsAll studies (N=19) from an ongoing Cochrane living systematic review on the effects of COVID-19 vaccination in people with AIRDs were included. We identified inequity factors using the PROGRESS-Plus framework which stands for Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital. Age, multimorbidity, and health literacy were also assessed as “Plus” factors. We applied the framework to assess equity considerations in relation to differences in COVID-19 baseline risk, description of participant characteristics, controlling for confounding factors, subgroup analysis and applicability of study findings.Results:Figure 1.All nineteen studies are cohort studies that followed individuals with AIRDs after COVID-19 vaccination. Two articles (11%) described differences in baseline risk for COVID-19 across age. All nineteen studies described participant age and sex, with race/ethnicity and multimorbidity described in four (21%) and occupation in one (5%). Seven studies (37%) controlled for age and/or sex as confounding factors. Eleven studies (58%) conducted subgroup analysis across at least one PROGRESS-Plus factor, most commonly age. Eight studies (42%) discussed at least one PROGRESS-Plus factor in interpreting the applicability of results, most commonly age (32%), then race/ethnicity and multimorbidity (11%).ConclusionIt is unknown whether COVID-19 vaccine studies on individuals with AIRDs are applicable to populations experiencing inequities, as key inequity factors beyond age and sex have little to no reporting or analysis. Future COVID-19 vaccine studies should report social characteristics of participants consistently, facilitating informed decisions about the applicability of study results to the population of interest.References[1]Whittle SL, Hazlewood GS, Robinson P, Johnston RV, Leder K, Glennon V, Avery JC, Grobler L, Buchbinder R. COVID-19 vaccination for people with autoimmune inflammatory rheumatic diseases on immunomodulatory therapies. Cochrane Database of Systematic Reviews 2021, Issue 6. Art. No.: CD014991. DOI: 10.1002/14651858.CD014991. Accessed 31 January 2022.[2]O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, Evans T, Pardo Pardo J, Waters E, White H, Tugwell P. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014 Jan;67(1):56-64. doi: 10.1016/j.jclinepi.2013.08.005. Epub 2013 Nov 1. PMID: 24189091.Disclosure of InterestsHarry Wang: None declared, Omar Dewidar: None declared, Samuel Whittle: None declared, Elizabeth Ghogomu: None declared, Glen Hazlewood: None declared, Lawrence Mbuagbaw Consultant of: Design, analysis and report for Janssen, Bayer and AstraZeneca, Jordi Pardo Pardo: None declared, Philip Robinson Speakers bureau: Pfizer, Lilly, Abbvie, UCB, GSK, Novartis, Paid instructor for: Lilly, Consultant of: Abbvie, Lilly, Janssen, Kukdong, Atom Biosciences, Grant/research support from: Janssen, Pfizer, UCB and Novartis, Rachelle Buchbinder: None declared, Vivian Welch: None declared
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Bartlett SJ, Schieir O, Valois MF, Boire G, Hazlewood G, Thorne C, Tin D, Hitchon C, Pope J, Keystone E, Bessette L, Bykerk V. OP0308-HPR MORE THAN HALF OF RA PATIENTS WITH A LIFETIME HISTORY OF MOOD DISORDERS WERE ANXIOUS AND DEPRESSED DURING THE COVID-19 PANDEMIC: RESULTS FROM THE CANADIAN EARLY COHORT (CATCH) STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundA growing number of studies indicate the considerable mental health impacts of the prolonged COVID-19 pandemic in the general population as chronic stress is a risk factor for the development of depression and anxiety. Mood disorders are more prevalent in RA and a history of anxiety or depressive disorders increases the risk of recurrence in the future.ObjectivesTo compare trends in prevalence of anxiety and depressive symptoms, prior to and during the COVID-19 pandemic in RA patients with and without a lifetime history of mood disorders.MethodsData were from RA patients diagnosed and treated for RA in rheumatology clinics across Canada enrolled in the Canadian Early Arthritis Cohort (CATCH) Study. We estimated monthly trends in prevalence of clinically significant levels of anxiety and depression (PROMIS Depression and Anxiety 4a score 55+) from all visits between Mar 2019 and Jan 2022 and compared monthly trends in anxiety and depression in the year prior to (Mar 2019- Feb 2020) and during the pandemic (Mar 2020 to Jan 2022) stratified by lifetime history of mood disorders.Results4,148 visits were completed from Mar 2019 to Jan 2022 in 1,644 RA patients with a mean (SD) age of 60 (14) and disease duration of 6 (4) years. 73% were women, 84% white, 60% had completed some post-secondary education, and 77% were in CDAI REM/LDA at the visit closest to the start of pandemic. 253 (15%) reported a lifetime history of depression and 217 (13%) a lifetime history of anxiety; 8% reported prior treatment for either.Patients with a history of mood disorders had higher levels of depression and anxiety prior-to and during the pandemic compared with patients without a history of mood disorders (Table 1). Proportions were highest during COVID waves in all and were substantially higher and more variable in people with a previous history of mood disorders as compared to those without a history (Figure 1). While depressive symptoms peaked early in the pandemic, anxiety increased with each wave, peaking in Wave 3 (May-Jun 2021).Table 1.Prevalence of depression and anxiety symptoms prior to and during the COVID-19 pandemic in RA patients with and without a history of mood disorders.Period Prevalence (monthly range)DepressionAnxietyNo historyPrior HistoryNo HistoryPrior HistoryN observations35276213610538Prepandemic (3/19 - 2/20)21%(14%-30%)51%(29%-64%)27%(20%-35%)58%(31%-89%)Pandemic (3/20 - 1/22)22%(15%-29%)53%(33%-78%)28%(20%-43%)59%(33%-80%)Figure 1.During the first 22 months of the COVID-19 pandemic, the proportion of patients with depression and anxiety increased in all groups. More than half of those with a history of emotional distress had clinically significant levels of depression and anxiety; proportions were highest during COVID waves in all and were substantially higher in people with previous history as compared to those without a history (see Figure 1). Whereas depressive symptoms peaked early in the pandemic, anxiety increased with each wave, peaking in Wave 3 (May-Jun 2021).ConclusionSymptoms of anxiety and depression were common in Canadian adults with RA prior to and after the onset of the COVID-19 pandemic. Whereas others have found that high levels of depression and anxiety occurred early in the pandemic but declined fairly rapidly in the general population1, emotional distress was not attenuated over time in this large cohort of RA patients. Individuals reporting lifetime history of mood disorders were more than twice as likely to report anxiety and depression, with depression peaking early in the pandemic and anxiety growing with each successive wave in the first year. The results demonstrate the importance of applying a lifetime perspective as previous episodes of anxiety and depression may be an important marker of increased vulnerability and recurrence in RA patients, particularly during the pandemic.References[1]Fancourt D et al. Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England. Lancet Psychiatry. 2021;8:141-9.AcknowledgementsCATCH is supported through unrestricted research grants from: Amgen and Pfizer Canada since 2007; AbbVie Corporation since 2011; Medexus since 2013; Sandoz Canada since 2019; Fresenius Kabi Canada since 2021 and; Organon Canada since 2021. Previous funding from Janssen Canada (2011-16); UCB Canada and Bristol-Myers Squibb Canada (2011-18); Hoffman La Roche Limited (2011-21); Sanofi Genzyme (2016-17); Eli Lilly Canada (2016-20); Merck Canada (2017-21) and; Gilead Sciences Canada (2020-21)Disclosure of InterestsNone declared
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Barber CEH, Lacaille D, Croxford R, Barnabe C, Marshall DA, Abrahamowicz M, Xie H, Avina-Zubieta JA, Esdaile JM, Hazlewood G, Faris P, Katz S, MacMullan P, Mosher D, Widdifield J. A Population-Based Study Evaluating Retention in Rheumatology Care Among Patients With Rheumatoid Arthritis. ACR Open Rheumatol 2022; 4:613-622. [PMID: 35514156 PMCID: PMC9274367 DOI: 10.1002/acr2.11442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The study objective was to assess adherence to system‐level performance measures measuring retention in rheumatology care and disease modifying anti‐rheumatic drug (DMARD) treatment in rheumatoid arthritis (RA). Methods We used a validated health administrative data case definition to identify individuals with RA in Ontario, Canada, between 2002 and 2014 who had at least 5 years of potential follow‐up prior to 2019. During the first 5 years following diagnosis, we assessed whether patients were seen by a rheumatologist yearly and the proportion dispensed a DMARD yearly (in those aged ≥66 for whom medication data were available). Multivariable logistic regression analyses were used to estimate the odds of remaining under rheumatologist care. Results The cohort included 50,883 patients with RA (26.1% aged 66 years and older). Over half (57.7%) saw a rheumatologist yearly in all 5 years of follow‐up. Sharp declines in the percentage of patients with an annual visit were observed in each subsequent year after diagnosis, although a linear trend to improved retention in rheumatology care was seen over the study period (P < 0.0001). For individuals aged 66 years or older (n = 13,293), 82.1% under rheumatologist care during all 5 years after diagnosis were dispensed a DMARD annually compared with 31.0% of those not retained under rheumatology care. Older age, male sex, lower socioeconomic status, higher comorbidity score, and having an older rheumatologist decreased the odds of remaining under rheumatology care. Conclusion System‐level improvement initiatives should focus on maintaining ongoing access to rheumatology specialty care. Further investigation into causes of loss to rheumatology follow‐up is needed.
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Affiliation(s)
- Claire E H Barber
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Cheryl Barnabe
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Deborah A Marshall
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Michal Abrahamowicz
- Arthritis Research Canada, Vancouver, British Columbia, Canada, and McGill University, Montreal, Quebec, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver British Columbia, Canada, and Simon Fraser University, Burnaby, British Columbia, Canada
| | - J Antonio Avina-Zubieta
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - John M Esdaile
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Glen Hazlewood
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | | | - Steven Katz
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Jessica Widdifield
- ICES, University of Toronto, and Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Canada
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Ta V, Schieir O, Valois MF, Colmegna I, Hitchon C, Bessette L, Hazlewood G, Thorne C, Pope J, Boire G, Tin D, Keystone EC, Bykerk VP, Bartlett SJ. Predictors of Influenza Vaccination in Early Rheumatoid Arthritis 2017-2021: Results From the Canadian Early Arthritis Cohort. ACR Open Rheumatol 2022; 4:566-573. [PMID: 35349768 PMCID: PMC9274339 DOI: 10.1002/acr2.11427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Adults with rheumatoid arthritis (RA) are at a higher risk for infections, including influenza and related complications. We identified influenza vaccination coverage in adults newly diagnosed with RA and examined sociodemographic RA characteristics and attitudes associated with vaccination. Methods We used data from patients enrolled in the Canadian Early Arthritis Cohort between September 2017 and February 2021. At enrollment, participants reported their vaccination status in the previous year and completed the Beliefs About Medicines Questionnaire (BMQ). Clinical data were obtained from medical records. Logistic regression was used to identify predictors of vaccination in the year after RA diagnosis. Results The baseline analytic sample of 431 patients were mostly White (80%) women (67%) with a mean age of 56 (SD 14) years. Prediagnosis, influenza vaccine coverage was 38%, increasing to 46% post diagnosis in the longitudinal sample (n = 229). Participants with previous influenza vaccination (odds ratio [OR] 15.33; 95% confidence interval [CI] 6.37‐36.90), on biologics or JAKs (OR 5.42; 95% CI 1.72‐17.03), and with a higher change in BMQ Necessity‐Concerns Differential scores (OR 1.08; 95% CI 1.02‐1.15) had greater odds, whereas women (OR 0.32; 95% CI 0.14‐0.71), participants with a non‐White racial background (OR 0.13; 95% CI 0.04‐0.51), and participants currently smoking (OR 0.09; 95% CI 0.02‐0.37) had lower odds of influenza vaccine coverage. Conclusion Influenza vaccination coverage in patients with early RA remains below national targets in adults living with a chronic condition. Discussing vaccine history and medication attitudes at initial clinic visits with new patients with RA may enhance vaccine acceptance and uptake.
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Affiliation(s)
- Viviane Ta
- McGill University, Montreal, Quebec, Canada
| | | | | | - Ines Colmegna
- McGill University and McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | | | - Carter Thorne
- The Arthritis Research Program, Newmarket, Ontario, Canada
| | - Janet Pope
- Western University, London, Ontario, Canada
| | - Gilles Boire
- University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Diane Tin
- The Arthritis Research Program, Newmarket, Ontario, Canada
| | | | - Vivian P Bykerk
- Hospital for Special Surgery, New York, New York, and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Susan J Bartlett
- McGill University and McGill University Health Centre, Montreal, Quebec, Canada
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Sloss S, Dhiman K, Zafar S, Hartfeld NMS, Lacaille D, Then KL, Li LC, Barnabe C, Hazlewood G, Rankin JA, Hall M, Marshall DA, English K, Tsui K, MacMullan P, Homik J, Mosher D, Barber CE. Development and testing of the Rheumatoid Arthritis Quality of Care Survey. Semin Arthritis Rheum 2022; 54:152002. [DOI: 10.1016/j.semarthrit.2022.152002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
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Rebić N, Munro S, Garg R, Hazlewood G, Amiri N, Baldwin C, Ensworth S, Proulx L, De Vera MA. “The medications are the decision-makers…” Making reproductive and medication use decisions among female patients with rheumatoid arthritis: a constructivist grounded theory. Arthritis Res Ther 2022; 24:31. [PMID: 35065668 PMCID: PMC8783434 DOI: 10.1186/s13075-021-02704-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/11/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To examine how female patients with RA form decisions about having children, pregnancy, and medication use.
Methods
We employed a constructivist grounded theory design and recruited female participants who are 18 years or older, have a rheumatologist-confirmed RA diagnosis, live in Canada, and are able to communicate in English or French. We collected data through semi-structured individual and focus group interviews using telephone or video conferencing technology. Data collection and analysis were iterative, employed theoretical sampling, reflexive journaling, and peer debriefing, and culminated in a theoretical model.
Results
We recruited 21 participants with a mean age of 34 years and median 10 years since RA diagnosis. Overall, 33% had never been pregnant, 57% had previously been pregnant, and 10% were pregnant at the time of interview. Of those who had experienced pregnancy, 64% had at least one pregnancy while diagnosed with RA and of those, 56% used DMARD(s) during a pregnancy. We constructed a patient-centred framework depicting the dynamic relationships between 4 decision-making processes—(1) using medications, (2) having children, (3) planning pregnancy, and (4) parenting—and the substantial impact of healthcare providers on patients’ experiences making these decisions. These processes were further influenced by participants’ intersecting identities and contextual factors, particularly attitudes towards health and medications, disease onset and severity, familial support system, and experiences interacting with the healthcare system.
Conclusion
Our framework provides insight into how patients make reproductive decisions in the context of managing RA and the opportunities for providers to support them at each decision-making process. A patient-centred care approach is suggested to support female patients with RA in making reproductive and medication choices aligning with their individual desires, needs, and values.
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Andersen KM, Schieir O, Valois MF, Bartlett SJ, Bessette L, Boire G, Haraoui B, Hazlewood G, Hitchon C, Keystone EC, Pope J, Tin D, Throne JC, Bykerk VP. A Bridge Too Far? Real-World Practice Patterns of Early Glucocorticoid Use in the Canadian Early Arthritis Cohort. ACR Open Rheumatol 2021; 4:57-64. [PMID: 34708574 PMCID: PMC8754017 DOI: 10.1002/acr2.11334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/05/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To describe patterns of glucocorticoid use in a large real-world cohort with early rheumatoid arthritis (RA) and assess the impact on disease activity and treatment. METHODS Data are from adults with new RA (≤1 year) recruited to the Canadian Early Arthritis Cohort (CATCH) and are stratified on the basis of whether a person was prescribed oral glucocorticoids within 3 months of study entry. Disease activity was compared over 24 months. Mixed-effects logistic regression was used for adjusted odds ratios (aORs) of escalation to biologics separately for 12 and 24 months, with random effects terms to account for prescribing patterns clustering by study site. RESULTS Among 1891 persons, 30% received oral steroids. Users were older, were less often employed, and had shorter disease duration and higher disease activity. Disease activity improved over time, with early glucocorticoid users starting at higher levels of disease activity. Participants with early oral glucocorticoids were more likely to be on a biologic at 12 months (aOR = 2.4; 95% confidence interval [CI], 1.5-3.7) and 24 months (aOR = 1.9; 95% CI, 1.3-3.0). Despite Canadian clinical practice guidelines to limit corticosteroid use to short-term or 'bridge' therapy, 30% of patients who used oral glucocorticoids still used them 2 years later. CONCLUSION Early steroids were prescribed sparingly in CATCH and were often indicative of more active baseline disease as well as the need for progression to biologics.
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Affiliation(s)
| | | | | | - Susan J Bartlett
- McGill University, Montreal, Quebec, Canada, and Johns Hopkins University, Baltimore, Maryland
| | - Louis Bessette
- Centre Hôspitalier Universitairé de Québec-Université Laval, Québec, Québec, Canada
| | - Gilles Boire
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Boulos Haraoui
- Institut de Rhumatologie de Montreal, Montreal, Quebec, Canada
| | | | | | | | - Janet Pope
- St. Joseph's Health Care London and University of Western Ontario, London, Ontario, Canada
| | - Diane Tin
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - J Carter Throne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Vivian P Bykerk
- Hospital for Special Surgery and Weill Cornell Medicine, New York City, New York
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Garg R, Rebić N, Amiri N, Hazlewood G, Baldwin C, Ensworth S, Proulx L, De Vera MA. Partners of female patients with rheumatoid arthritis and reproductive decision-making: a constructivist grounded theory study. Rheumatol Adv Pract 2021; 5:rkab040. [PMID: 34557621 PMCID: PMC8452997 DOI: 10.1093/rap/rkab040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/24/2021] [Indexed: 11/12/2022] Open
Abstract
Objective Partners of patients with RA often take on supportive roles given the debilitating nature of RA. Our objective was to explore the perspectives, attitudes and experiences of partners of female patients with RA regarding reproductive experiences and decision-making. Methods We conducted a qualitative study involving semi-structured interviews with partners of female patients with RA. We defined a partner as an individual within a romantic relationship. Constructivist grounded theory was applied to interview transcripts to identify and conceptualize themes. Results We interviewed 10 partners of female patients with RA (10 males; mean age, 35 [23–56] years), of whom 40% had at least one child with a female patient with RA and did not desire additional children. We identified four themes representing stages of reproductive decision-making: (1) developing an understanding of RA, (2) contemplating future family decision-making, (3) initiating reproductive decision-making with partner, and (4) reflecting on past reproductive experiences. Participants contemplated their attitudes and perspectives regarding pregnancy and used available information to support their partner’s medication decisions. When reflecting on their reproductive experiences, participants shared the impacts of past reproductive decisions on their romantic relationship and their mental health and wellbeing. Conclusion Our study highlights the need for comprehensive support for both female patients with RA and their partners at all stages of reproductive decision-making. Health-care providers can identify opportunities for intervention that involves female patients with RA and their partners to minimize stress and its negative impacts on the family.
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Affiliation(s)
- Ria Garg
- Faculty of Pharmaceutical Sciences, University of British Columbia.,Collaboration for Outcomes Research and Evaluation, Vancouver
| | - Nevena Rebić
- Faculty of Pharmaceutical Sciences, University of British Columbia.,Collaboration for Outcomes Research and Evaluation, Vancouver.,Arthritis Research Canada, Richmond
| | - Neda Amiri
- Arthritis Research Canada, Richmond.,Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, BC
| | - Glen Hazlewood
- Collaboration for Outcomes Research and Evaluation, Vancouver.,Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Corisande Baldwin
- Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, BC
| | - Stephanie Ensworth
- Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, BC
| | - Laurie Proulx
- Canadian Arthritis Patient Alliance, Ottawa, ON, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia.,Collaboration for Outcomes Research and Evaluation, Vancouver.,Arthritis Research Canada, Richmond
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Umaefulam V, Fox TL, Hazlewood G, Bansback N, Barber CEH, Barnabe C. Adaptation of a Shared Decision-Making Tool for Early Rheumatoid Arthritis Treatment Decisions with Indigenous Patients. Patient 2021; 15:233-243. [PMID: 34486098 PMCID: PMC8866334 DOI: 10.1007/s40271-021-00546-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
Background Patient decision aids (PtDAs) enable shared decision-making between patients and healthcare providers. Adaptations to PtDAs for use with populations facing inequities in healthcare can improve the relevancy of information presented, incorporate appropriate cultural context, and address health literacy concerns. Our objective was to adapt the Early RA (rheumatoid arthritis) PtDA for use with Canadian Indigenous patients. Methods The Early RA PtDA was modified through an iterative process using data obtained from semi-structured interviews of two sequential cohorts of Indigenous patients with RA. Interview data were analyzed using thematic analysis. Results Seven participants provided initial feedback on the existing PtDA. The modifications they suggested were made and shared with another nine participants to confirm acceptability and provide further feedback. The first cohort suggested revisions to clarify medical and cost coverage information, include Indigenous traditional healing practice options, simplify text, and include Indigenous images and colors aligned with Canadian Indigenous community representation. Additional revisions were suggested by the second cohort to increase the legibility of the text, insert more Indigenous imagery, address formulary coverage for non-status First Nations patients, and include information about lifestyle factors in managing RA. Conclusion Incorporating Indigenous-specific adaptations in the design of PtDAs may increase use and relevancy to support engagement in treatment decisions, thereby supporting health-equity oriented health service interventions. Indigenous patient-specific evidence and translation of key words into the end-users’ Indigenous languages should be included for implementation of the PtDA. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00546-8.
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Affiliation(s)
- Valerie Umaefulam
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Nick Bansback
- Centre for Health Evaluation and Outcome Sciences at St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Arthritis Research Canada, Richmond, British Columbia, Canada.
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Fatima S, Schieir O, Valois MF, Bartlett SJ, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone EC, Tin D, Thorne C, Bykerk VP, Pope JE, Investigators C. Validity of the Health Assessment Questionnaire Predicting All-Cause Mortality in Early Rheumatoid Arthritis: Reply to three letters to the editor. Arthritis Rheumatol 2021; 74:178-180. [PMID: 34224658 DOI: 10.1002/art.41918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 11/12/2022]
Abstract
We appreciate the interest in our manuscript concerning the Health Assessment Questionnaire disability index (HAQ) in an early rheumatoid arthritis incident cohort (the CATCH cohort) which predicted all-cause mortality (1). We will clarify queries raised in letters to the editor (2-4).
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Affiliation(s)
- Safoora Fatima
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - O Schieir
- University of Toronto, Toronto, Ontario, Canada
| | - M F Valois
- McGill University, Montreal, Quebec, Canada
| | | | - L Bessette
- CHU de Québec-Université Laval, Laval, Quebec, Canada
| | - G Boire
- Division of Rheumatology, Department of Medicine, Université de Sherbrooke
| | - G Hazlewood
- University of Calgary, Calgary, Alberta, Canada
| | - C Hitchon
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - D Tin
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - C Thorne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - V P Bykerk
- University of Toronto, Toronto, Ontario, Canada.,Hospital for Special Surgery, Weill Cornell Medical College, New York, USA
| | - J E Pope
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Division of Rheumatology, St. Joseph's Health Care London, London, Ontario, Canada
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Barnabe C, Pianarosa E, Hazlewood G. Informing the GRADE evidence to decision process with health equity considerations: demonstration from the Canadian rheumatoid arthritis care context. J Clin Epidemiol 2021; 138:147-155. [PMID: 34161803 DOI: 10.1016/j.jclinepi.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Health equity is a priority for clinical and public health practice and promoted in GRADE's Evidence to Decision (EtD) Framework, yet there is still limited integration of specific equity considerations in chronic disease guideline development and implementation. Our objective was to embed equity considerations for upcoming Canadian Rheumatoid Arthritis treatment guidelines. STUDY DESIGN AND SETTING In parallel with the Guidelines Committee process, considerations for six population groups (rural and remote residents, Indigenous Peoples, elderly persons with frailty, minority populations of first-generation immigrants and refugees, persons with low socioeconomic status or who are vulnerably housed, and sex and gender populations) based on literature reviews and key informant interviews were identified and contextualized to each step in the GRADE EtD framework. RESULTS The EtD Framework domains relevant to rheumatoid arthritis treatment and management were analyzed through patient-centric, social determinant and economic lenses, while considering implementation feasibility. This determined tailored considerations relevant to recommendations for the priority populations to mitigate potential intervention-generated inequities. CONCLUSION This approach provides a demonstration of the process of incorporating equity in the evidence to decision process and can be applied in future rheumatic disease guidelines while also informing a research agenda for equity in rheumatology outcomes.
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Affiliation(s)
- Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, Canada.
| | - Emilie Pianarosa
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Arthritis Research Canada, Richmond, Canada
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Bartlett SJ, Schieir O, Valois MF, Boire G, Pope J, Keystone E, Thorne C, Tin D, Hitchon C, Bessette L, Hazlewood G, Bykerk V. OP0262-HPR THE NEURO-QOL UPPER EXTREMITY FUNCTION SCALE: NEW OPPORTUNITIES TO MORE RELIABLY AND PRECISELY MEASURE SELF-REPORTED HAND FUNCTION AND SELF-CARE ACTIVITIES IN PEOPLE WITH RA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:RA is an inflammatory disease that results in pain and loss of function, especially in the hands and wrists. Brief self-assessment tools that can reliably and precisely quantify hand/wrist function are needed to assess inflammatory activity when a physical exam is not feasible and to capture day-to-day experience of living with RA. Neuro-QoL is part of the PROMIS family of self-report measures created using a patient-centred approach and IRT methodology. The Neuro-Qol Upper Extremity Function (UEF) scale measures ability across fine motor and ADLs involving digital, manual and reach-related function and self-care. Little is known about its performance in RA.Objectives:To evaluate the validity and responsiveness of the 8-item Neuro-QoL UEF in RA. We hypothesized scores would be strongly (r>.70) associated with MHAQ, MD-HAQ, and PROMIS PF, moderately (r=.4 to .7) to symptoms, disease activity, and QoL indicators, and be responsive to change in disease activity and PF.Methods:Data were from the 0 and 6-month visits of adults with early RA (sx <1 yr) enrolled in the Canadian Early Arthritis Cohort, a prospective real-world study at 16 sites across Canada. Participants completed the Neuro-QoL UEF, MHAQ, MDHAQ, PROMIS-29, and PT Global at each visit. Rheumatologists recorded joint counts and MD Global. To evaluate content validity, we examined descriptive statistics across CDAI disease activity levels, and Pearson correlations between the Neuro-QOL UEF, legacy measures, CRP & ESR. Responsiveness was assessed by correlating change scores from visits 0-6 between Neuro-QoL UEF, disease activity and legacy PF scores.Results:The 262 participants were mostly white (83%) women (71%) with a mean (SD) age of 55 (13). Summary statistics at 6-months are shown in Table 1. Neuro-QOL UEF was moderately-strongly correlated with MHAQ, MDHAQ, PROMIS-PF (|r|=.63-.75) and moderately correlated with pain and stiffness, (|r|=.59, -.64), and CDAI, SDAI, PT&MD Global, TJ & SJ (|r|=.39-.58). Neuro-QOL UEF was moderately correlated with PROMIS QoL domains Pain, Fatigue, Anxiety, Depression, Sleep & Participation (|r|=.39-.60).Table 1.Summary statistics of physical function and RA disease activity indices at 6 months.MeanSDMdn25%75%(Min, Max)Physical FunctionNeuro-Qol UEF46.59.753.837.553.8(21.8, 53.8)MHAQ (0-3)0.290.430.130.000.38(0.00, 2.25)MD-HAQ (0-10)1.391.640.700.002.00(0.00, 8.00)PROMIS-PF46.48.546.239.556.0(23.3, 56.0)RA Disease ActivityCDAI9.39.96.03.013.0(0.0, 56.0)SDAI10.710.96.83.115.2(0.0, 57.0)Patient Global3.02.5315(0, 10)MD Global1.82.2103(0, 9)Swollen Joints (28)2.13.7002(0, 20)Tender Joints (28)2.43.9103(0, 24)Neuro-QOL scores decreased in a dose-response manner across worsening CDAI DA states reflecting increasing impairment (Table 2). Persons with HDA reported the highest disability, scoring nearly 0.5 SD lower on the Neuro-QoL UEF than PROMIS PF. Change from baseline to 6 months in Neuro-QoL UEF was moderately correlated with changes in PROMIS PF, MHAQ, PT Global, and CDAI (|r|=.44-.65). The mean change and range from 0-6 months in Neuro-QoL was significantly larger than in PROMIS (8.9 [95% CI 7.5, 10.4] vs. 5.4 [95% CI 4.4, 6.4])(see Figure).Table 2.Mean scores (95% CI) at 6 months by CDAI level.REMLDAMDAHADNeuroQol UEF52.8 (51.8, 53.7)48.1 (46.6, 49.7)42.0 (39.4, 44.6)33.8 (30.5, 37.1)MHAQ (0-3)0.05 (0.02, 0.09)0.19 (0.14, 0.24)0.45 (0.34, 0.57)0.90 (0.63, 1.17)MD-HAQ (0-10)0.31 (0.17, 0.46)1.11 (0.90, 1.32)2.15 (1.71, 2.59)3.56 (2.56, 4.56)PROMIS-PF52.8 (51.4, 54.2)46.8 (45.3, 48.2)42.3 (40.4, 44.2)38.0 (34.4, 41.6)Conclusion:Clinicians, researchers, and patients benefit from practical self-report tools that reliably and precisely monitor hand function in RA. Results offer initial evidence of validity and responsiveness and support use of Neuro-QoL UEF to self-assess inflammatory activity in the hands and day-to-day experiences of living with RA.Acknowledgements:The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013;, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019,Gilead Sciences Canada since 2020 and Fresenius Kabi Canada Ltd. since 2021. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, Sanofi Genzyme from 2016-2017, and Eli Lilly Canada from 2016-2020.Disclosure of Interests:None declared
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Bartlett SJ, Bingham C, Schieir O, Valois MF, Hazlewood G, Pope J, Thorne C, Tin D, Hitchon C, Bessette L, Boire G, Keystone E, Bykerk V. POS1459-HPR IDENTIFYING MEANINGFUL CHANGE IN THE RA FLARE QUESTIONNAIRE SCORES IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The RA-FQ is a patient-reported measure of current disease activity in RA that can be used to identify disease flares. The RA-FQ queries pain, physical function, fatigue, stiffness, and participation and yields a score from 0-50. We previously reported on reliability, validity, and responsiveness.Objectives:To identify changes in RA-FQ that represent minimal and meaningful improvement or worsening from the perspective of people with RA, treating rheumatologists, and in relation to disease activity indices. We hypothesized thatMethods:Data were from adults with early RA (sx <1 year) enrolled in the Canadian Early Arthritis Cohort, a prospective study of real-world patients treated across Canada. Participants completed the RA-FQ, Patient Global, and RA transition item since last visit (a little vs. a lot better or worse or same) between consecutive 3- and 6-month visits. Rheumatologists recorded joint counts, MD Global, and change in RA. We compared mean change across improvement and worsening using patient anchors and disease activity indicators.Results:The 808 adults were mostly white (84%) women (71%) with a mean (SD) age of 55 (15) and moderate-high CDAI level (85%) at enrollment. Most (79%) reported their RA had changed; 59% were better and 20% worse. Patients who were a lot worse had a mean increase of 8.9 points whereas those who rated themselves as a lot better had a -6.0 decrease on the RA-FQ (Figure 1). Minimal worsening and improvement were associated with 4.7 and -1.8 change in RA-FQ scores, respectively, while patients who rated their RA unchanged had stable RA-FQ scores (Table 1).Similar changes were evident in CDAI, SDAI, and DAS indices (Table 1). Larger differences were observed with patient vs. physician global scores and tender vs. swollen joints. Across measures, the change associated with worsening was greater than for improvement. Results supported all prespecified hypotheses ab.Table 1.Spearman’s correlation coefficients of PsAQoL with the other parameters for construct validityDomainA Lot Better(N=346; 43%)A Little Better(N=132; 16%)The Same(N=174; 21%)A Little Worse(N=94; 12%)A Lot Worse(N=62; 8%)Δ95% CISDΔ95% CISDΔ95% CISDΔ95% CISDΔ95% CISDRA-FQ Total (0-50)-6.0(-7.1, -4.9)10.3-1.8(-3.2, -0.3)8.4-0.1(-1.3, 1.1)8.14.7(2.9, 6.6)9.18.9(5.1, 12.7)15.0 Pain-1.2(-1.4, -0.9)2.4-0.4(-0.8, 0.0)2.30.0(-0.2, 0.3)1.81.3(0.8, 1.7)2.22.0(1.2, 2.9)3.3 Physical Function-1.3(-1.6, -1.1)2.4-0.3(-0.6, 0.1)2.10.0(-0.3, 0.3)2.10.9(0.4, 1.4)2.41.8(0.8, 2.7)3.7 Fatigue-1.1(-1.4, -0.8)2.6-0.4(-0.7, 0.0)1.90.0(-0.3, 0.3)2.10.7(0.3, 1.1)2.11.3(0.5, 2.1)3.2 Stiffness-1.1(-1.4, -0.9)2.4-0.4(-0.7, 0.0)2.0-0.1(-0.4, 0.2)2.01.1(0.6, 1.5)2.21.8(1.0, 2.7)3.3 Participation-1.2(-1.5, -1.0)2.5-0.1(-0.5, 0.3)2.1-0.1(-0.4, 0.2)2.20.8(0.4, 1.3)2.22.0(1.1, 2.8)3.4Disease ActivityCDAI*-5.3(-6.3, -4.3)9.1-3.3(-5.4, -1.3)11.5-0.8(-2.0, 0.5)8.11.7(-0.1, 3.5)8.86.8(3.7, 9.8)12.0SDAI-5.6(-6.8, -4.4)9.2-3.5(-6.1, -0.9)12.2-1.9(-3.6, -0.2)8.91.5(-0.7, 3.7)9.24.7(1.0, 8.4)12.2DAS28-CRP-0.7(-0.8, -0.6)1.01-0.5(-0.7, -0.2)1.2-0.2(-0.4, 0.0)1.00.3(0.1, 0.5)1.00.5(0.2, 0.9)1.2Patient Global (0-10)-1.3(-1.5, -1.0)2.7-0.5(-0.9, -0.1)2.1-0.1(-0.4, 0.2)2.11.3(0.8, 1.8)2.42.9(2.1, 3.6)3.1MD Global (0-10)-1.2(-1.4, -1.0)1.9-0.7(-1.1, -0.3)-0.1-0.1(-0.4, 0.2)1.90.1(-0.3, 0.5)2.80.7(0.0, 1.5)2.8Swollen Joints (28)-1.4(-1.7, 1.0)3.2-1.0(-1.8, -0.2)4.6-0.4(-0.9, 0.0)3.00.0(-0.7, 0.7)3.41.3(0.2, 2.5)4.6Tender Joints (28)-1.5(-1.9, -1.1)3.9-1.3(-2.2, -0.3)5.50.0(-0.7, 0.6)4.30.3(-0.7, 1.2)4.52.2(0.8, 3.5)5.4Conclusion:In this large cohort of adults with ERA, the RA-FQ was responsive to change and generally distinguish between minimal and meaningful improvement and worsening. These data add to a growing evidence demonstrating robust psychometric properties of the RA-FQ and offer initial guidance about the amount of change associated with improvement or worsening, supporting its use in RA care, research and decision-making.Acknowledgements:The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013;, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019,Gilead Sciences Canada since 2020 and Fresenius Kabi Canada Ltd. since 2021. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, Sanofi Genzyme from 2016-2017, and Eli Lilly Canada from 2016-2020.Disclosure of Interests:None declared
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Hadwen B, Stranges S, Klar N, Bindee K, Pope J, Bartlett SJ, Boire G, Bessette L, Hitchon C, Hazlewood G, Keystone E, Schieir O, Thorne C, Tin D, Valois MF, Bykerk V, Barra L. POS0531 FACTORS ASSOCIATED WITH BASELINE HYPERTENSION IN EARLY RHEUMATOID ARTHRITIS: DATA FROM A REAL-WORLD LARGE INCIDENT COHORT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:It is not well understood why hypertension (HTN) is so common in rheumatoid arthritis (RA) patients. Reported prevalence of HTN in RA patients ranges from 4-73%.(1)Objectives:This study explored the prevalence of HTN at time of RA diagnosis and which demographic, behavioural and clinical factors were associated with HTN.Methods:Data from the Canadian Early Arthritis Cohort (CATCH), a prospective inception cohort of patients with RA <1 year duration, were used to analyze baseline demographic, behavioural and clinical characteristics associated with HTN, which was reported by physicians. Univariate logistic regression models were created to explore associations with baseline HTN. A multivariate logistic regression model was built based on goodness of fit indicated by likelihood ratio tests. Variables included in the model were age, sex, race, body mass index (BMI), education, smoking, alcohol servings, seropositivity, disease activity and comorbidities.Results:In total, 2052 subjects were included with mean (±SD) age of 55 (±14) years and symptom duration 5.60(5.47, 5.73) months, 71% of subjects were female and 85% were Caucasian. HTN was reported in 26% of subjects at baseline. Hypertensive subjects were older and more likely to be male. Other factors significantly associated with HTN at baseline were lower education, ever smoking, high BMI, diabetes, hyperlipidemia, worse RA disease activity, longer duration of RA symptoms, being seropositive, as well as the use of NSAIDs and/or corticosteroids (Table 1). In multivariable analysis HTN was associated with older age, overweight and obese BMI, diabetes, and hyperlipidemia. Expression of anti-citrullinated protein antibodies was inversely associated with HTN (Table 1). Other RA disease factors and treatments were not significantly associated with HTN on multivariable analysis.Table 1.Results of univariate and multivariate logistic regression analyses exploring the association between baseline characteristics and HTN in early RA.Univariate Logistic RegressionMultivariable Logistic RegressionVariableCrude OR (95% CI)Adjusted OR (95% CI)Socio-Demographic20-39 years old0.15 (0.07, 0.26)0.14(0.05, 0.34)40-59 years oldReference60-79 years old2.81 (2.26, 3.50)2.26(1.65, 3.11)80-99 years old5.87 (3.36,10.25)3.80(1.53, 9.41)Female0.55 (0.45, 0.68)1.10(0.78, 1.54)Lifestyle/BehaviouralNormal weight (18.5- 24.9kg/m2)ReferenceOverweight (25-29.9 kg/m2)2.33(1.74, 3.11)1.63(1.10, 2.43)Obese (30+ kg/m2)3.19(2.38, 4.27)2.84(1.91, 4.23Ever-smoking1.41(1.15, 1.73)1.02(0.75, 1.40)Post-secondary education0.58(0.47, 0.71)0.88(0.65, 1.20)Clinical CharacteristicsSymptom duration0.99(0.99, 0.99)1.00(1.00, 1.00)DAS-281.09(1.09, 1.17)1.02(0.92, 1.13)ACPA+0.68(0.56, 0.85)0.64(0.44, 0.92)Corticosteroid use pre-baseline1.37(1.04, 1.81)OmittedNSAID use at baseline0.68(0.55, 0.84)OmittedDiabetes5.62(4.09, 7.73)3.20(1.99, 5.15)Hyperlipidemia4.75(3.74, 6.03)2.80(1.94, 4.02),CVD15.59(3.35, 72.64)OmittedDAS-28; Disease activity score 28, ACPA; Anti-citrullinated protein antibody, CVD; Cardiovascular disease. Pre-baseline is 29 to 365 days before entering the cohort. Baseline is within 28 days before entering the cohort. Omitted variables either failed likelihood ratio test or were colinear. Additional variables tested but found insignificant: race, alcohol servings, depression, RF+, and use of DMARDs.Conclusion:Approximately 1 in 4 diagnosed with RA had HTN reported by their rheumatologists, which is similar to that of the general population. This suggests that increased risk of HTN in RA patients may develop as RA disease or treatment time progresses. Factors that may be predictive of this excess risk will be explored in further analysis.References:[1]Panoulas VF, Metsios GS, Pace AV, et al. Hypertension in rheumatoid arthritis. Rheumatology (Oxford) 2008;47:1286-98.Acknowledgements:The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013;, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019,Gilead Sciences Canada since 2020 and Fresenius Kabi Canada Ltd. since 2021. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, Sanofi Genzyme from 2016-2017, and Eli Lilly Canada from 2016-2020.Disclosure of Interests:Brook Hadwen: None declared, Saverio Stranges: None declared, Neil Klar: None declared, Kuriya Bindee: None declared, Janet Pope Speakers bureau: UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, BMS, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB;, Grant/research support from: Abbvie, BMS, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Gilles Boire Speakers bureau: Merck, BMS, Pfizer, Janssen, Grant/research support from: Amgen, Abbvie, BMS, Eli Lilly, Merck, Novartis, Pfizer, Sandoz, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Consultant of: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis., Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis., Carol Hitchon Grant/research support from: Pfizer and UCB Canada, Glen Hazlewood: None declared, Edward Keystone Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Consultant of:: AbbVie, Amgen, AstraZeneca Pharma, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Grant/research support from: AbbVie, Amgen, Gilead Sciences, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, PuraPharm, Sanofi, Orit Schieir: None declared, Carter Thorne Speakers bureau: Medexus/Medac, Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Grant/research support from: Amgen, Pfizer, Abbvie, Celgene, CaREBiodam, Novartis, Diane Tin: None declared, Marie-France Valois: None declared, Vivian Bykerk Consultant of: Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB, NIH, Lillian Barra: None declared
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Thomas M, Fraenkel L, Boonen A, Bansback N, Buchbinder R, Marshall D, Proulx L, Voshaar M, Richards P, Richards DP, Hiligsmann M, Guillemin F, Shea B, Tugwell P, Hazlewood G. Patient preferences to value health outcomes in rheumatology clinical trials: Report from the OMERACT special interest group ✰. Semin Arthritis Rheum 2021; 51:919-924. [PMID: 34134892 DOI: 10.1016/j.semarthrit.2021.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To inform a research plan for future studies by obtaining stakeholder input on the application of preference-based methods to clinical trial design. METHODS We conducted a virtual OMERACT session to encourage stakeholder engagement. We developed materials for the session to facilitate discussion based on identified case examples and feedback sessions. RESULTS Participants prioritized incorporating patient preferences in all aspects of trial design with an emphasis on outcome selection. Participants highlighted the need for careful consideration around preference heterogeneity and equity factors. CONCLUSION Including patient preferences in trial design was considered a priority requiring further exploration to develop comprehensive guidance.
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Affiliation(s)
- Megan Thomas
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Liana Fraenkel
- Yale University School of Medicine, Section of Rheumatology, CT, USA
| | - Annelies Boonen
- Department of Internal Medicine, Maastricht University Medical Center, Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Nick Bansback
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University and Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia
| | | | - Laurie Proulx
- Patient research partner, Canadian Arthritis Patient Alliance, Ottawa, Canada
| | - Marieke Voshaar
- Patient research partner, Radboud University, Department of Pharmacy, Nijmegen, the Netherlands
| | - Pamela Richards
- Patient research partner, University Hospitals, Bristol NHS Trust, Bristol, UK
| | - Dawn P Richards
- Patient research partner, Canadian Arthritis Patient Alliance, Ottawa, Canada; Patient research partner, Five02 Labs Inc., Toronto, Canada
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - Beverly Shea
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Glen Hazlewood
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Medicine, University of Calgary, Calgary, Canada.
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Pianarosa E, Hazlewood G, Thomas M, Hsiao R, Barnabe C. Supporting Equity in Rheumatoid Arthritis Outcomes in Canada: Population-specific Factors in Patient-centered Care. J Rheumatol 2021; 48:1793-1802. [PMID: 33993108 DOI: 10.3899/jrheum.210016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Health equity considerations have not been incorporated into prior Canadian Rheumatology Association guidelines. Our objective was to identify the challenges and possible solutions to mitigate threats to health equity in rheumatoid arthritis (RA) care in Canada. METHODS A consultation process informed selection of priority populations, determined to be rural and remote, Indigenous, elderly with frailty, first-generation immigrant and refugee, low income and vulnerably housed, and diverse gender and sex populations. Semistructured interviews were completed with patients with lived experience, healthcare providers, and equity-oriented researchers. These interviews probed on population factors, initial and ongoing healthcare access issues, and therapeutic considerations influencing RA care. Known or proposed solutions to mitigate inequities during implementation of service models for the population group were requested. The research team used a phenomenological thematic analysis model and mapped the data into a logic model. Solutions applicable to several population groups were proposed. RESULTS Thirty-five interviews were completed to identify realities for each population in accessing RA care. Five themes emerged as primary solutions to population-based inequities, including actively improving the patient-practitioner relationship, increasing accessibility and coordination of care through alternative models of care, upholding autonomy in treatment selection while actively addressing logistical barriers and individualized therapy needs, collaborating with health supports valued by the patient, and being advocates for policy change and health system restructuring to ensure appropriate resource redistribution. CONCLUSION The challenges for populations facing inequities in rheumatology care and promising solutions should inform guideline development and implementation, policy change, and health system restructuring.
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Affiliation(s)
- Emilie Pianarosa
- This study is funded by the Canadian Institutes of Health Research Foundation Scheme (CB). EP is supported by a Canadian Institutes of Health Research Institute of Musculoskeletal Health and Arthritis Undergraduate Summer Studentship. CB is the Canada Research Chair in Rheumatoid Arthritis and Autoimmune Diseases. E. Pianarosa, BSc, MSc student, Dalla Lana School of Public Health, University of Toronto; G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; M. Thomas, MSc Student, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; R. Hsiao, MSc, MD student, Undergraduate Medical Education Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Barnabe, 3330 Hospital Dr NW, Calgary AB T2N4N1, Canada. . Accepted for publication April 30, 2021
| | - Glen Hazlewood
- This study is funded by the Canadian Institutes of Health Research Foundation Scheme (CB). EP is supported by a Canadian Institutes of Health Research Institute of Musculoskeletal Health and Arthritis Undergraduate Summer Studentship. CB is the Canada Research Chair in Rheumatoid Arthritis and Autoimmune Diseases. E. Pianarosa, BSc, MSc student, Dalla Lana School of Public Health, University of Toronto; G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; M. Thomas, MSc Student, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; R. Hsiao, MSc, MD student, Undergraduate Medical Education Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Barnabe, 3330 Hospital Dr NW, Calgary AB T2N4N1, Canada. . Accepted for publication April 30, 2021
| | - Megan Thomas
- This study is funded by the Canadian Institutes of Health Research Foundation Scheme (CB). EP is supported by a Canadian Institutes of Health Research Institute of Musculoskeletal Health and Arthritis Undergraduate Summer Studentship. CB is the Canada Research Chair in Rheumatoid Arthritis and Autoimmune Diseases. E. Pianarosa, BSc, MSc student, Dalla Lana School of Public Health, University of Toronto; G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; M. Thomas, MSc Student, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; R. Hsiao, MSc, MD student, Undergraduate Medical Education Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Barnabe, 3330 Hospital Dr NW, Calgary AB T2N4N1, Canada. . Accepted for publication April 30, 2021
| | - Ralph Hsiao
- This study is funded by the Canadian Institutes of Health Research Foundation Scheme (CB). EP is supported by a Canadian Institutes of Health Research Institute of Musculoskeletal Health and Arthritis Undergraduate Summer Studentship. CB is the Canada Research Chair in Rheumatoid Arthritis and Autoimmune Diseases. E. Pianarosa, BSc, MSc student, Dalla Lana School of Public Health, University of Toronto; G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; M. Thomas, MSc Student, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; R. Hsiao, MSc, MD student, Undergraduate Medical Education Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Barnabe, 3330 Hospital Dr NW, Calgary AB T2N4N1, Canada. . Accepted for publication April 30, 2021
| | - Cheryl Barnabe
- This study is funded by the Canadian Institutes of Health Research Foundation Scheme (CB). EP is supported by a Canadian Institutes of Health Research Institute of Musculoskeletal Health and Arthritis Undergraduate Summer Studentship. CB is the Canada Research Chair in Rheumatoid Arthritis and Autoimmune Diseases. E. Pianarosa, BSc, MSc student, Dalla Lana School of Public Health, University of Toronto; G.S. Hazlewood, MD, PhD, Associate Professor, C. Barnabe, MD, MSc, Associate Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; M. Thomas, MSc Student, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; R. Hsiao, MSc, MD student, Undergraduate Medical Education Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. C. Barnabe, 3330 Hospital Dr NW, Calgary AB T2N4N1, Canada. . Accepted for publication April 30, 2021
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Rebić N, Garg R, Ellis U, Kitchin V, Munro S, Hazlewood G, Amiri N, Bansback N, De Vera MA. "Walking into the unknown…" key challenges of pregnancy and early parenting with inflammatory arthritis: a systematic review and thematic synthesis of qualitative studies. Arthritis Res Ther 2021; 23:123. [PMID: 33882998 PMCID: PMC8059168 DOI: 10.1186/s13075-021-02493-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background To conduct a systematic review and thematic synthesis of qualitative studies on the pregnancy and early parenting experiences of patients with inflammatory arthritis (IA). Methods We searched online databases for English-language, qualitative studies capturing the experiences of females with IA or their healthcare providers with pregnancy and/or early parenthood. We extracted findings from included studies and used thematic synthesis to develop descriptive and higher-order analytical themes. Results Of 20 included studies, our analysis identified 5 analytical themes among patients and 3 among providers. Patients’ reproductive desires, the impact of IA on their ability to experience pregnancy, and the availability of information to guide preparedness informed their pregnancy decisions. Patients’ IA management, pregnancy expectations, and access to support influenced their reproductive experiences. Patients’ experiences seeking information and care revealed substantial gaps in reproductive care provision to patients with IA. Reproductive uncertainty related to IA placed a heavy burden on patients’ emotional and psychological wellbeing. Reproductive care provision was influenced by providers’ perceived professional responsibility to address patients’ reproductive goals, fears of negative outcomes, and capacity to harness patient trust, incorporate reproductive care into rheumatology practice and facilitate multi-disciplinary care coordination. Conclusions Our review illuminated several barriers to experiencing pregnancy among patients with IA, particularly related to pregnancy planning support, availability of information, and care coordination among the patient’s healthcare team. To improve care, these barriers may be mitigated through the provision of relevant, practical, and consistent information as well as patient-centred multi-disciplinary approaches for managing pregnancy among patients with IA.
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Affiliation(s)
- Nevena Rebić
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Arthritis Research Centre of Canada, 5591 Number 3 Rd, Richmond, BC, V6X 2C7, Canada.,Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ria Garg
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ursula Ellis
- University of British Columbia Library, 2198 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Vanessa Kitchin
- University of British Columbia Library, 2198 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC, V6Z 2K8, Canada.,Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard Street St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada
| | - Glen Hazlewood
- Arthritis Research Centre of Canada, 5591 Number 3 Rd, Richmond, BC, V6X 2C7, Canada.,Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
| | - Neda Amiri
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of British Columbia, 802-1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada
| | - Nick Bansback
- Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard Street St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.,School of Populations and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Arthritis Research Centre of Canada, 5591 Number 3 Rd, Richmond, BC, V6X 2C7, Canada. .,Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Barber C, Lacaille D, Hall M, Bohm V, Li LC, Barnabe C, Rankin J, Hazlewood G, Marshall DA, Macmullan P, Mosher D, Homik J, English K, Tsui K, Then KL. Strategies for developing and implementing a rheumatoid arthritis healthcare quality framework: a thematic analysis of perspectives from arthritis stakeholders. BMJ Open 2021; 11:e043759. [PMID: 33674373 PMCID: PMC7938986 DOI: 10.1136/bmjopen-2020-043759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To obtain stakeholder perspectives to inform the development and implementation of a rheumatoid arthritis (RA) healthcare quality measurement framework. DESIGN Qualitative study using thematic analysis of focus groups and interviews. SETTING Arthritis stakeholders from across Canada including healthcare providers, persons living with RA, clinic managers and policy leaders were recruited for the focus groups and interviews. PARTICIPANTS Fifty-four stakeholders from nine provinces. INTERVENTIONS Qualitative researchers led each focus group/interview using a semistructured guide; the digitally recorded data were transcribed verbatim. Two teams of two coders independently analysed the transcripts using thematic analysis. RESULTS Perspectives on the use of different types of measurement frameworks in healthcare were obtained. In particular, stakeholders advocated for the use of existing healthcare frameworks over frameworks developed in the business world and adapted for healthcare. Persons living with RA were less familiar with specific measurement frameworks, however, they had used existing online public forums for rating their experience and quality of healthcare provided. They viewed a standardised framework as potentially useful for assisting with monitoring the care provided to them individually. Nine guiding principles for framework development and 13 measurement themes were identified. Perceived barriers identified included access to data and concerns about how measures in the framework were developed and used. Effective approaches to framework implementation included having sound knowledge translation strategies and involving stakeholders throughout the measurement development and reporting process. Clinical models of care and health policies conducive to outcome measurement were highlighted as drivers of successful measurement initiatives. CONCLUSION These important perspectives will be used to inform a healthcare quality measurement framework for RA.
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Affiliation(s)
- Claire Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc Hall
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Victoria Bohm
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Linda C Li
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
| | - James Rankin
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
| | - Deborah A Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
| | - Paul Macmullan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Mosher
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joanne Homik
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly English
- Arthritis Patient Advisory Board, Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Karen Tsui
- Arthritis Patient Advisory Board, Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Karen L Then
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Iragorri N, Hazlewood G, Manns B, Bojke L, Spackman E. Model to Determine the Cost-Effectiveness of Screening Psoriasis Patients for Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2021; 73:266-274. [PMID: 31733035 DOI: 10.1002/acr.24110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Screening psoriasis patients for psoriatic arthritis (PsA) is intended to identify patients at earlier stages of the disease. Early treatment is expected to slow disease progression and delay the need for biologic therapy. Our objective was to determine the cost-effectiveness of screening for PsA in patients with psoriasis in Canada. METHODS A Markov model was built to estimate the costs and quality-adjusted life years (QALYs) of screening tools for PsA in psoriasis patients. The screening tools included the Toronto Psoriatic Arthritis Screen, Psoriasis Epidemiology Screening Tool, Psoriatic Arthritis Screening and Evaluation, and Early Psoriatic Arthritis Screening Questionnaire (EARP) questionnaires. States of health were defined by disability levels as measured by the Health Assessment Questionnaire. State transitions were modeled based on annual disease progression. Incremental cost-effectiveness ratios and incremental net monetary benefits were estimated. Sensitivity analyses were undertaken to account for parameter uncertainty and to test model assumptions. RESULTS Screening was cost-effective compared to no screening. The EARP tool had the lowest total cost ($2,000 per patient per year saved compared to no screening) and the highest total QALYs (additional 0.18 per patient compared to no screening). The results were most sensitive to test accuracy and the efficacy of disease-modifying antirheumatic drugs (DMARDs). No screening was cost-effective (at $50,000 per QALY) relative to screening when DMARDs failed to slow disease progression. CONCLUSION If early therapy with DMARDs delays biologic treatment, implementing screening in patients with psoriasis in Canada is expected to represent a cost savings of $220 million per year and improve the quality of life.
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Affiliation(s)
- Nicolas Iragorri
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Glen Hazlewood
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Braden Manns
- Cumming School of Medicine, University of Calgary, Calgary, and Alberta Health Services, Edmonton, Alberta, Canada
| | | | - Eldon Spackman
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Wilson T, Javaheri P, Finlay J, Hazlewood G, Wilton SB, Sajobi T, Levin A, Pearson W, Connolly C, James MT. Treatment Preferences for Cardiac Procedures of Patients With Chronic Kidney Disease in Acute Coronary Syndrome: Design and Pilot Testing of a Discrete Choice Experiment. Can J Kidney Health Dis 2021; 8:2054358120985375. [PMID: 33552527 PMCID: PMC7844446 DOI: 10.1177/2054358120985375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/27/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Chronic kidney disease is associated with a high incidence of acute coronary syndrome and related morbidity and mortality. Treatment choices for patients with chronic kidney disease involve trade-offs in the potential benefits and harms of invasive management options. Objective: The objective was to quantify preferences of patients with chronic kidney disease toward invasive heart procedures. Design: Design and pilot a discrete choice experiment. Setting: We piloted the discrete choice experiment in 2 multidisciplinary chronic kidney disease clinics in Calgary, Alberta, using an 8-question survey. Patients: Eligible patients included those aged 18 years and older, an estimated glomerular filtration rate < 45 mL/min/1.73 m2, not currently receiving dialysis, and able to communicate in English. Measurements: Quantification of the average importances of key attributes of invasive heart procedures. Methods: We identified attributes most important to patients and physicians concerning invasive versus conservative management for acute coronary syndrome, using semi-structured qualitative interviews. Levels for each attribute were derived from analysis of early invasive versus conservative acute coronary syndrome management clinical trials and cohort studies, where subgroups of patients with chronic kidney disease were reported. We designed the pilot study with patient partners with relevant lived experience and considered statistical efficiency to estimate main effects and interactions, as well as response efficiency. Hierarchical Bayesian estimation was used to quantify average importances of attributes. Results: We recruited 43 patients with chronic kidney disease, mean (SD) age 67 (14) years, 67% male, and 35% with a history of cardiovascular disease, of whom 39 completed the survey within 2 weeks of enrollment. The results of the pilot revealed acute kidney injury requiring dialysis and permanent kidney replacement therapy, as well as death within 1 year were the most important attributes. Measures of internal validity for the pilot discrete choice experiment were comparable to those for other published discrete choice experiments. Limitations: Discrete choice experiments are complex instruments and often cognitively demanding for patients. This survey included multiple risk attributes which may have been challenging for some patients to understand. Conclusions: This pilot study demonstrates the feasibility of a discrete choice experiment to quantify preferences of patients with chronic kidney disease toward the benefits and trade-offs related to invasive versus conservative management for acute coronary syndrome. These preliminary findings suggest that patients with chronic kidney disease may be on average similarly risk averse toward kidney replacement therapy and death. This pilot information will be used to inform a larger discrete choice experiment that will refine these estimates of patient preferences and characterize subgroups with distinct treatment preferences, which should provide new knowledge that can facilitate shared decision-making between patients with chronic kidney disease and their care providers in the setting of acute coronary syndrome.
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Affiliation(s)
- T Wilson
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - P Javaheri
- Department of Medicine, University of Calgary, AB, Canada
| | - J Finlay
- Department of Medicine, University of Calgary, AB, Canada
| | - G Hazlewood
- Department of Medicine, University of Calgary, AB, Canada
| | - S B Wilton
- Department of Cardiac Sciences, University of Calgary, AB, Canada
| | - T Sajobi
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - A Levin
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - W Pearson
- Patient and Community Engagement Research Program, O'Brien Institute of Public Health, University of Calgary, AB, Canada
| | - C Connolly
- Department of Cardiac Sciences, University of Calgary, AB, Canada
| | - M T James
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
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Holdren M, Schieir O, Bartlett SJ, Bessette L, Boire G, Hazlewood G, Hitchon CA, Keystone E, Tin D, Thorne C, Bykerk VP, Pope JE. Improvements in Fatigue Lag Behind Disease Remission in Early Rheumatoid Arthritis: Results From the Canadian Early Arthritis Cohort. Arthritis Rheumatol 2020; 73:53-60. [DOI: 10.1002/art.41499] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/06/2020] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Gilles Boire
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Estrie–Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke Sherbrooke Quebec Canada
| | | | | | | | - Diane Tin
- Southlake Regional Health Centre Newmarket Ontario Canada
| | - Carter Thorne
- Southlake Regional Health Centre Newmarket Ontario Canada
| | - Vivian P. Bykerk
- Mount Sinai Hospital, Toronto, Ontario, Canada, and Hospital for Special Surgery and Weill Cornell Medicine New York New York
| | - Janet E. Pope
- University of Western Ontario and St. Joseph's Health Care London London Ontario Canada
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Pianarosa E, Chomistek K, Hsiao R, Anwar S, Umaefulam V, Hazlewood G, Barnabe C. Global Rural and Remote Patients with Rheumatoid Arthritis: A Systematic Review. Arthritis Care Res (Hoboken) 2020; 74:598-606. [PMID: 33181001 PMCID: PMC9304257 DOI: 10.1002/acr.24513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/21/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022]
Abstract
Objective Rural and remote patients with rheumatoid arthritis (RA) are at risk for inequities in health outcomes based on differences in physical environments and health care access potential compared to urban populations. The aim of this systematic review was to synthesize epidemiology, clinical outcomes, and health service use reported for global populations with RA residing in rural and remote locations. Methods Medline, Embase, HealthStar, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library were searched from inception to June 2019 using librarian‐developed search terms for RA and rural and remote populations. Peer‐reviewed published manuscripts were included if they reported on epidemiologic, clinical, or health service use outcomes. Results Fifty‐four articles were included for data synthesis, representing studies from all continents. In 11 studies in which there was an appropriate urban population comparator, rural and remote populations were not at increased risk for RA; 1 study reported increased prevalence, and 5 studies reported decreased prevalence in rural and remote populations. Clinical characteristics of rural and remote populations in studies with an appropriate urban comparator showed no significant differences in disease activity measures or disability, but 1 study reported worse physical function and health‐related quality of life in rural and remote populations. Studies reporting on health service use provided evidence that rural and remote residence adversely impacts diagnostic time, ongoing follow‐up, access to RA‐care–related practitioners and services, and variation in medication access and use, with prominent heterogeneity noted between countries. Conclusion RA epidemiology and clinical outcomes are not necessarily different between rural/remote and urban populations within countries. Rural and remote patients face greater barriers to care, which increases the risk for inequities in outcomes.
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Affiliation(s)
| | - Kelsey Chomistek
- Medical Sciences Faculty of Graduate Studies University of Calgary Calgary AB Canada
| | - Ralph Hsiao
- Medical Education Faculty of Medicine & Dentistry University of Alberta Edmonton AB Canada
| | - Salman Anwar
- Medical Education University of Saskatchewan Saskatoon SK Canada
| | | | - Glen Hazlewood
- Departments of Medicine and Community Health Sciences Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences Cumming School of Medicine University of Calgary 3330 Hospital Dr NW Calgary AB T2N 4N1 Canada
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Brignardello-Petersen R, Florez ID, Izcovich A, Santesso N, Hazlewood G, Alhazanni W, Yepes-Nuñez JJ, Tomlinson G, Schünemann HJ, Guyatt GH. GRADE approach to drawing conclusions from a network meta-analysis using a minimally contextualised framework. BMJ 2020; 371:m3900. [PMID: 33177059 DOI: 10.1136/bmj.m3900] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Ivan D Florez
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
- Department of Pediatrics, School of Medicine, University of Antioquia, Medellín, Colombia
| | - Ariel Izcovich
- Internal Medicine Service, German Hospital, Buenos Aires, Argentina
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Waleed Alhazanni
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | | | - George Tomlinson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
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Brignardello-Petersen R, Izcovich A, Rochwerg B, Florez ID, Hazlewood G, Alhazanni W, Yepes-Nuñez J, Santesso N, Guyatt GH, Schünemann HJ. GRADE approach to drawing conclusions from a network meta-analysis using a partially contextualised framework. BMJ 2020; 371:m3907. [PMID: 33172877 DOI: 10.1136/bmj.m3907] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Ariel Izcovich
- Internal Medicine Service, German Hospital, Buenos Aires, Argentina
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Ivan D Florez
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
- Department of Pediatrics, School of Medicine, University of Antioquia, Medellín, Colombia
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Waleed Alhazanni
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | | | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
- GRADE Centre and Department of Medicine, McMaster University, Hamilton, ON, Canada
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Barnabe C, Chomistek K, Luca N, Hazlewood G, Barber CEH, Steiman A, Stringer E. National Priorities for High-quality Rheumatology Transition Care for Youth in Canada. J Rheumatol 2020; 48:426-433. [PMID: 33060318 DOI: 10.3899/jrheum.200790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To conduct a needs assessment and environmental scan to support optimal transition from pediatric to adult rheumatology care in Canada. METHODS This initiative involved 3 phases: (1) a survey-based needs assessment of adult and pediatric rheumatologist members of the Canadian Rheumatology Association to identify perceived infrastructure, educational needs, and national resources to support transition care; (2) an environmental scan, through semistructured interviews, of existing rheumatology transition service care models and challenges in care delivery; and (3) a focus group to prioritize national activities. RESULTS The needs assessment survey was completed by 65 members, with 66% agreeing that a national approach to transition care was needed. Semistructured interviews reflecting activities at 9 transition care sites were conducted, and they identified candidate models of care, including direct transfer, progressive transfer, and shared care models. Challenges and needs experienced in these care models reflected resource and infrastructure needs, poor availability of mechanisms to support parents and youth through the transition process, and the need for evaluation to support quality improvement. The focus group and prioritization activity was attended by 26 participants, with each having the ability to cast 3 votes. "Supporting patient education for transition to adult rheumatology health care system" (n = 17 votes) and "advocacy activities to access allied health support, including funding" (n = 10 votes) emerged as the top priorities for national initiatives. CONCLUSION We have identified priorities in education and advocacy for advancing transition care in Canada that require participation of pediatric and adult rheumatology providers, patients, and arthritis stakeholders in the interest of advancing transition care outcomes.
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Affiliation(s)
- Cheryl Barnabe
- C. Barnabe, MD, MSc, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Past-Chair, Quality Care Committee, Canadian Rheumatology Association;
| | - Kelsey Chomistek
- K. Chomistek, BSc, Masters of Science student, Faculty of Graduate Studies, University of Calgary, Calgary, Alberta
| | - Nadia Luca
- N. Luca, MD, MSc, Clinical Assistant Professor in the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Executive, Pediatrics Committee, Canadian Rheumatology Association
| | - Glen Hazlewood
- G. Hazlewood, MD, PhD, Assistant Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Member, Quality Care Committee, Canadian Rheumatology Association
| | - Claire E H Barber
- C.E. Barber, MD, PhD, Assistant Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Member, Quality Care Committee, Canadian Rheumatology Association
| | - Amanda Steiman
- A. Steiman, MD, MSc, Assistant Professor, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, and Chair, Quality Care Committee, Canadian Rheumatology Association
| | - Elizabeth Stringer
- E. Stringer, MD, Associate Professor, Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, and Member, Pediatrics Committee, Canadian Rheumatology Association, Canada
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Fatima S, Schieir O, Valois MF, Bartlett SJ, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone EC, Tin D, Thorne C, Bykerk VP, Pope JE. Health Assessment Questionnaire at One Year Predicts All-Cause Mortality in Patients With Early Rheumatoid Arthritis. Arthritis Rheumatol 2020; 73:197-202. [PMID: 32892510 DOI: 10.1002/art.41513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/06/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Higher self-reported disability (high Health Assessment Questionnaire [HAQ] score) has been associated with hospitalizations and mortality in established rheumatoid arthritis (RA), but associations in early RA are unknown. METHODS Patients with early RA (symptom duration <1 year) enrolled in the Canadian Early Arthritis Cohort who initiated disease-modifying antirheumatic drugs and had completed HAQ data at baseline and 1 year were included in the study. Discrete-time proportional hazards models were used to estimate crude and multi-adjusted associations of baseline HAQ and HAQ at 1 year with all-cause mortality in each year of follow-up. RESULTS A total of 1,724 patients with early RA were included. The mean age was 55 years, and 72% were women. Over 10 years, 62 deaths (3.6%) were recorded. Deceased patients had higher HAQ scores at baseline (mean ± SD 1.2 ± 0.7) and at 1 year (0.9 ± 0.7) than living patients (1.0 ± 0.7 and 0.5 ± 0.6, respectively; P < 0.001). Disease Activity Score in 28 joints (DAS28) was higher in deceased versus living patients at baseline (mean ± SD 5.4 ± 1.3 versus 4.9 ± 1.4) and at 1 year (mean ± SD 3.6 ± 1.4 versus 2.8 ± 1.4) (P < 0.001). Older age, male sex, lower education level, smoking, more comorbidities, higher baseline DAS28, and glucocorticoid use were associated with mortality. Contrary to HAQ score at baseline, the association between all-cause mortality and HAQ score at 1 year remained significant even after adjustment for confounders. For baseline HAQ score, the unadjusted hazard ratio (HR) was 1.46 (95% confidence interval [95% CI] 1.02-2.09), and the adjusted HR was 1.25 (95% CI 0.81-1.94). For HAQ score at 1 year, the unadjusted HR was 2.58 (95% CI 1.78-3.72), and the adjusted HR was 1.75 (95% CI 1.10-2.77). CONCLUSION Our findings indicate that higher HAQ score and DAS28 at 1 year are significantly associated with all-cause mortality in a large early RA cohort.
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Affiliation(s)
- Safoora Fatima
- University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - O Schieir
- University of Toronto, Toronto, Ontario, Canada
| | - M F Valois
- McGill University, Montreal, Quebec, Canada
| | | | - L Bessette
- CHU de Québec-Université Laval, Laval, Québec, Canada
| | - G Boire
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie, CHU de Sherbrooke, and Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - G Hazlewood
- University of Calgary, Calgary, Alberta, Canada
| | - C Hitchon
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - D Tin
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - C Thorne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - V P Bykerk
- University of Toronto, Toronto, Ontario, Canada, and Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
| | - J E Pope
- University of Western Ontario Schulich School of Medicine and Dentistry and St. Joseph's Health Care London, London, Ontario, Canada
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Loyola-Sanchez A, Hazlewood G, Crowshoe L, Linkert T, Hull PM, Marshall D, Barnabe C. Qualitative Study of Treatment Preferences for Rheumatoid Arthritis and Pharmacotherapy Acceptance: Indigenous Patient Perspectives. Arthritis Care Res (Hoboken) 2020; 72:544-552. [PMID: 30821924 PMCID: PMC7187260 DOI: 10.1002/acr.23869] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/26/2019] [Indexed: 12/12/2022]
Abstract
Objective To explore patient preferences that influence decision‐making in the management of rheumatoid arthritis (RA) by indigenous patients living in southern Alberta, Canada. Methods We conducted a qualitative narrative‐based study within a social constructivist framework. Thirteen in‐depth interviews with indigenous patients with RA who had attended 1 of 3 rheumatology practices in southern Alberta (1 rural and 2 urban) were completed. Codes generated through 2 phases of analysis were condensed into main themes, triangulated, and used to produce theoretical statements. Results Patients preferred to use a combination of nonpharmacologic and pharmacologic treatments to manage their RA. Nonpharmacologic treatments included physical, mental, emotional, and spiritual strategies. Patients’ preferences for taking medications varied and were influenced by factors that were clinical (i.e., trust in health providers and understanding drugs’ mechanisms of action, benefits, harms, and administration burden), familial (i.e., support), and societal (i.e., access to medications and stigmatization of drug dependency). Conclusion Indigenous patients apply a holistic approach to the nonpharmacologic management of RA. Increases in preferences for RA medications could be supported through enhanced communication strategies to increase patient understanding of medication effects and health provider recognition of societal and familial influences on patient decisions. A patient–provider relationship based on trust was fundamental to reaching mutual understanding and should be fostered by models of practice that promote cultural safety, empathy, compassion, openness, acknowledgment, and respect of cultural differences.
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Affiliation(s)
| | - Glen Hazlewood
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden Crowshoe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tessa Linkert
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pauline M Hull
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Marshall
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Weiler M, Schieir O, Valois MF, Bartlett SJ, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne C, Bykerk V, Pope J. SAT0127 REAL-WORLD PREDICTORS OF STARTING DIFFERENT ADVANCED DMARD TREATMENTS IN RHEUMATOID ARTHRITIS: A PROSPECTIVE INVESTIGATION FROM THE CANADIAN EARLY ARTHRITIS COHORT (CATCH) GROUP. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:RA patients with inadequate DMARD response may be treated with a TNF inhibitor (TNFi), non-TNFi or janus kinase inhibitor (JAKi) [1].Objectives:Compare characteristics of real-world early RA (ERA) patients starting TNFi, non-TNFi, and JAKi post DMARD failure.Methods:Data were analyzed from early RA patients (symptoms < 1 year) enrolled in CATCH who started TNFi, non-TNFi or JAKi as first line advanced therapy from 2014 to 2019. Descriptive statistics, t-tests and chi-square tests summarized and compared secular trends and patient characteristics initiating each class of therapy. Multinomial logistic regression analyses were done.Results:246 participants started advanced therapy during the study period; (75%) female, mean(SD) age 50(14) years. First line prescriptions for JAKi increased and TNFi decreased (Fig. 1). Those receiving JAKi had longer disease duration, fewer tender joints, and lower DAS28, CDAI, ESR, MD global (all p <0.05) (Table 1). The strongest predictor of starting JAKi was province (Ontario where access is preferential for JAKi and biosimilar TNFi) (Table 2). Those prescribed TNFi had shorter disease duration, younger age, fewer comorbidities, and treatment location outside Ontario (Table 1,2). Those starting non-TNFi had higher DAS28; predictors included older age, higher education, and more comorbidities (Table 1,2).Table 1.Characteristics prior to starting advanced therapyVariableTotal Sample(N = 246)JAKi(N = 61)TNFi(N = 153)Non-TNFi(N = 32)p-value£Disease duration (months) mean (SD)39 (34.1)50.8 (39.3)32.5 (29.1)48 (38.6)0.0006DAS28 (ESR - CRP if ESR was missing) mean (SD)4.2 (1.4)3.6 (1.4)4.3 (1.4)4.8 (1.5)0.0012CDAI mean (SD)21.5 (14.8)16.5 (13.7)22.9 (14.8)24.8 (14.9)0.0089Tender joint count (0-28), median (IQR)§4 (7)2 (6)5 (8)6 (9)0.0224ESR median (IQR)§13 (20)12 (13)13 (20)28.0 (23.5)0.0448MD Global (0-10) mean (SD)4.2 (2.7)3.2 (2.7)4.4 (2.6)4.8 (2.8)0.0030§IQR: 75 – 25 percentile£p-value: ANOVA for continuous variable, chi-square for categoricalTable 2.Multinomial regression for initiating advanced DMARD therapyDisease stage & Clinical Disease ActivityAdvanced DMARDAdjusted for Age, sex, education, comorbidityFullyAdjustedφNon-TNF vs TNFJAK vsTNFNon-TNF vs TNFJAK vsTNFAge1.01 (0.98, 1.05)1.01 (0.99, 1.04)1.01 (0.97, 1.05)1.02 (0.99, 1.05)Women vs Men1.98 (0.71, 5.58)1.33 (0.63, 2.80)2.35 (0.76, 7.27)1.72 (0.73, 4.02)Education(< HS vs ≥ HS)2.92 (1.28, 6.63)1.49 (0.78, 2.86)2.83 (1.12, 7.15)2.08 (0.97, 4.47)RDCI baseline1.35 (1.01, 1.81)1.21 (0.95, 1.53)1.30 (0.95, 1.78)1.23 (0.94, 1.60)Private Insurance(No vs Yes)NINI1.26 (0.47, 3.40)0.99 (0.44, 2.25)RF PositiveNINI1.47 (0.56, 3.85)1.84 (0.82, 4.12)CDAININI1.01 (0.98, 1.04)0.97 (0.94, 1.00)RegionQuebec vs Ontario (ON)NINI0.59 (0.20, 1.72)0.44 (0.20, 0.94)West vs ONNINI1.32 (0.29, 5.98)0.11 (0.01, 0.99)φAdjusted for; baseline age, sex, education, RDCI; province; RF positive in first year; private insurance; CDAI at visit prior to initiationConclusion:Patient and physician related factors (location of practice) determined which advanced therapeutic was prescribed. JAKi use is increasing in ERA.Reference:[1]Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the Rheumatic Diseases Published Online First: 22 January 2020Disclosure of Interests:Madina Weiler: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, LillyPharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Vivian Bykerk: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB
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Ta V, Schieir O, Valois MF, Hazlewood G, Hitchon C, Bessette L, Tin D, Thorne C, Pope J, Boire G, Keystone E, Bykerk V, Bartlett SJ. FRI0030 MORE THAN HALF OF NEWLY DIAGNOSED RA PATIENTS ARE NOT CONVINCED OF THE NECESSITY OF RA MEDICINES: ASSOCIATIONS WITH RA CHARACTERISTICS, SYMPTOMS, AND FUNCTION IN THE CANADIAN EARLY ARTHRITIS COHORT (CATCH). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Although DMARDs are essential for early aggressive control of RA to reduce symptoms and disability, medication adherence is variable. Beliefs about the necessity of medications and safety concerns predict adherence and are modifiable.Objectives:To examine associations among RA medication necessity beliefs and concerns, sociodemographics, RA characteristics, symptom level and function in newly diagnosed RA patients.Methods:Baseline data were analyzed from participants in the Canadian Early Arthritis Cohort (CATCH) who enrolled between 2017-2020 and completed the Beliefs about Medicine Questionnaire (BMQ) and PROMIS-29. All met ACR1987 or 2010 ACR/EULAR criteria and had active RA at enrollment. BMQ Necessity (N) and Concerns (C) scores were classified ashigh(≥20) orlow(<20) and categorized into: Accepting (↑N ↓C); Ambivalent (↑N↑C); Sceptical (↓N↑C); and 4) Indifferent (↓N↓C). Groups were compared using ANOVA and chi-square tests.Results:The 362 patients were mostly white (83%) women (66%) with a mean (SD) age of 56 (15), symptom duration of 6 (3) months, and 32% were obese (BMI≥30). More than half (56%) were DMARD-naive or minimally exposed. Mean N and C scores were similar between men and women; 54% were classified asIndifferent, 31%Accepting, 9%Ambivalent,and 6%Sceptical.As compared to those classified asAccepting, moreIndifferent participantssmoked, had a healthy weight, lower TJCs, and trend for lower CDAI (Table). Groups were similar by sociodemographics, symptom duration, and DMARD/steroid use, except fewerIndifferentpatients received MTX.Indifferentpatients had statistically and meaningfully lower patient global, depression, anxiety, fatigue and pain interference, and higher function and participation scores (Table).Conclusion:Many new RA patients had low medication necessity beliefs and concerns, and only 31% had high necessity beliefs and low concerns around diagnosis. Lifestyle and lower CDAI, TJCs, symptoms and functional impacts were associated with RA medication indifference. Identifying medication indifference can prompt discussions about medication beliefs/concerns to facilitate shared decision-making and adherence.Disclosure of Interests:Viviane Ta: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Vivian Bykerk: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie
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Andersen N, Schieir O, Valois MF, Boire G, Pope J, Hazlewood G, Bessette L, Hitchon C, Tin D, Thorne C, Keystone E, Bykerk V, Bartlett SJ. OP0263-HPR MAJOR STRESSORS IN THE YEAR PRIOR TO RA DIAGNOSIS: IMPACT ON PATIENT-REPORTED OUTCOMES ONE YEAR LATER. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Stress is implicated in RA onset and poorer prognoses through changes in neuro-endocrine and autoimmune function. Although many people with RA link disease onset to recent stressful life events, results from retrospective studies are unclear.Objectives:To describe the incidence of major stressors(+STRESS) in year prior to diagnosis and compare characteristics and patient-reported outcomes (PROs) of newly diagnosed RA patients with and without+STRESSat 0 and 12 months.Methods:Data were from early RA patients (symptoms <1 yr) enrolled in the Canadian Early Arthritis Cohort (CATCH) from 2007-17 who met 1987/2010 ACR/EULAR criteria and had ≥12 months of follow-up. Patients reported major psychological (death, divorce/separation, family, financial, other) and physical (motor vehicle accident, surgery, major illness/infection, other) stressors in previous year. We used independent t-tests and chi square to compare characteristics by stressors at baseline, and multivariable regression to examine the impact of+STRESSon disease activity and PROs at 1 year, adjusting for age, sex, education, fibromyalgia, and SJC.Results:The 1933 adults were mostly female (72%), with a mean (SD) age of 55 (15) years. 52% reported 1+ stressors in previous year; family (48%), financial stress (36%), death (35%), surgery (28%), and major illness (26%) were the most common stressors. Patients with +STRESS were more likely to be women, younger, have more comorbidities including fibromyalgia, and higher mean DAS28. Patients with +STRESS also had significantly higher mean pain, fatigue, depression, sleep disturbance, patient global, and HAQ scores at baseline.At 1 year, SJC and the proportion in DAS28 REM was similar between groups. However, PROs (pain, HAQ, Fatigue, Pt Global, Depression, Poor Sleep) remained higher in+STRESS, with evidence of an additive effect for number of stressors and having both physical and psychological stressors (Table). The greatest impacts were on mood, sleep disturbance, and fatigue.Conclusion:In this pan-Canadian early RA cohort, more than half reported 1+ stressful life events in the year prior to diagnosis. Individuals reporting major stressors had significantly worse pain, patient global, disability, depression, fatigue, and sleep disturbance at diagnosis; 1 year later, though disease activity was similar between groups, the effects of +STRESS on PROs persisted. Early RA patients with recent major stressors may benefit from emotional support and stress reduction to optimize how they feel and function.Mean (SD) or N (%)No Stress(N=928; 48%)Physical(N=131; 7%)Psychological(N=658; 34%)Both(N=216; 11%)Age56 (15)56 (15)53 (14)52 (15)Women622 (67%)82 (63%)512 (78%)174 (81%)College Education464 (50%)76 (58%)345 (52%)126 (58%)Rheum Dis Comorbid Index1.1 (1.2)1.4 (1.4)1.1 (1.3)1.4 (1.3)OA or Spinal pain168 (18%)35 (27%)117 (18%)55 (25%)Fibromyalgia diagnosis15 (2%)2 (2%)13 (2%)11 (5%)Symptom duration (months)5.6 (3.0)5.7 (3.0)5.9 (3.0)5.9 (3.0)DAS28 – mean5.0 (1.4)5.1 (1.5)5.0 (1.5)5.2 (1.4)MTX ±csDMARDs679 (73%)100 (76%)489 (74%)166 (77%)Oral Steroids295 (32%)40 (31%)215 (33%)55 (25%)Pain (0-10)5.3 (2.8)5.5 (2.9)5.7 (2.8)6.2 (2.8)HAQ-DI1.0 (0.7)1.2 (0.7)1.1 (0.7)1.3 (0.7)Fatigue (0-10)4.7 (3.1)5.0 (3.0)5.7 (2.9)5.9 (2.9)Patient Global (0-10)5.6 (2.9)6.0 (2.9)6.0 (2.9)6.4 (3.0)Depression (SF12 MCS < 45.6)329 (35%)54 (41%)356 (54%)123 (57%)Poor sleep (0-10)4.5 (3.4)4.8 (3.3)5.3 (3.2)6.0 (3.1)Disclosure of Interests:Nicole Andersen: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Glen Hazlewood: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, PfizerSpeakers bureau: Medexus/Medac, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, LillyPharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Vivian Bykerk: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie
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Schieir O, Hazlewood G, Bartlett SJ, Valois MF, Bessette L, Boire G, Hitchon C, Keystone E, Pope J, Thorne C, Tin D, Bykerk V. FRI0024 HOW OFTEN DOES REACHING TARGET MISS THE MARK? LONGITUDINAL PATTERNS OF REMISSION IN REAL-WORLD EARLY RHEUMATOID ARTHRITIS PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Early diagnosis and rapid initiation of DMARDs following a treat-to-target approach have made remission a realizable goal for many with RA. Yet, some patients are unable to sustain remission over time.Objectives:To describe longitudinal patterns of remission and identify predictors of sustained vs transient remission in real-world early RA patients.Methods:Data were from the Canadian Early Arthritis Cohort (CATCH), a prospective study of early RA patients (symptoms < 1 year) treated in rheumatology clinics across Canada from 2007- 2019. The sample was limited to patients with active disease at enrolment who later reached remission (SDAI<=3.3) and were followed for 12-24 months thereafter. Patients were classified as in sustained remission (Pattern 1) or transient remission with transient remission patients divided into those who transitioned from REM to LDA only (Pattern 2) and those who transitioned from REM to MDA or HDA (Pattern 3), over FU. Multi-adjusted multinomial regression was used to identify predictors of transient remission patterns.Results:The study included 1,419 (46%) CATCH participants that reached remission. At enrolment, most (70%) were female, mean(sd) SDAI was high (27(15)) and 92% were treated with csDMARDs. Only 47% remained in sustained remission by 12-months and, only 40% by 24 months (Pattern 1) (Figure). Among patients with transient remission patterns, transitions to LDA only (Pattern 2) were more common than to MDA/HDA over FU (Pattern 3) (Fig 1). Older age, female sex, smoking, higher comorbidity index and positive serology, were significantly associated with transient remission patterns (Table). There were also borderline significant associations between transient remission patterns and longer time to remission, lack of early MTX treatment and reducing treatment after remission (Table).Table .Adjusted Multinomial Regression Results of Predictors of Transient Remission Patterns over 24-Month Follow UpPattern 2 vs, Pattern 1OR (95% CI)Pattern 3 vs. Pattern 1OR (95% CI)Age1.01 (1.00, 1.02)1.01 (0.99, 1.02)Women vs Men1.78 (1.33, 2.39)1.63 (1.09, 2.44)Current smoker1.57 (1.09, 2.28)1.53 (0.95, 2.47)RDCI at baseline1.11 (0.99, 1.25)1.30 (1.13, 1.50)Seropositive1.38 (1.03, 1.85)1.21 (0.81, 1.80)MTX first 3 months1.18 (0.85, 1.63)0.76 (0.51, 1.12)Time to remission (months)1.01 (1.00, 1.01)1.01 (1.00, 1.02)Treatment reduction after REM vs. No Change1.33 (0.96, 1.86)1.01 (0.99, 1.02) Pattern 1: Sustained REM Pattern 2: Transient REM: Transitions to LDA only Pattern 3: Transient REM: Transitions to MDA/HDA RDCI: Rheumatic Disease Comorbidity Index (range 0-9) Treatment reduction: Change from biologic or JAK to csDMARD(s) OR reduction in number of csDMARDs OR change from MTX +/- csDMARDs to non-MTX csDMARDFigure.Distribution of Disease Activity States over 12-24 After First Achieving SDAI REMConclusion:Results of this large longitudinal analysis of real-world data suggests that < 50% of patients that reach remission sustain remission for 12-24months. Closer monitoring of patients with prognostic indicators for transient remission and additional research focusing on why remission is lost may help improve the rates of sustained remission.References:[1]Ajeganova S, Huizinga T. Sustained remission in rheumatoid arthritis: latest evidence and clinical considerations. Ther Adv Musculoskelet Dis. 2017;9(10):249-62.Disclosure of Interests:Orit Schieir: None declared, Glen Hazlewood: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Marie-France Valois: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Diane Tin: None declared, Vivian Bykerk: None declared
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Bykerk V, Schieir O, Valois MF, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne C, Pope J, Bartlett SJ. FRI0032 REGIONAL AND WIDESPREAD PATTERNS OF NON-ARTICULAR PAIN ARE COMMON AT RA DIAGNOSIS AND CONTRIBUTE TO POOR OUTCOMES AT 12 MONTHS: A PROSPECTIVE STUDY OF PAIN PATTERNS IN CANADIANS WITH RA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Persistent pain can occur in early RA patients, despite improvement in synovitis and may be due to coexisting non-articular pain (NAP). Though NAP is often attributed to fibromyalgia and widespread NAP, regional NAP syndromes may be more common and under-recognized.Objectives:To describe patterns of NAP, predictors of persistent NAP and impact on outcomes in the first year following early RA diagnosis.Methods:Data were from participants enrolled in the Canadian Early Arthritis Cohort (CATCH) between2017-2019who completed 0,6,12-month evaluations with patient-reported outcomes [PROs] and clinical data available. We used the McGill Body Pain Diagram (BPD) to classify patients as experiencing no NAP, regional (RP:1-2 regions) or widespread NAP (WP:3-5 regions). Multinomial regression was used to identify baseline predictors of persistent RP and WP at 12-months. Multi-adjusted GEE with linear and logit links were used to estimate time-varying associations of NAP patterns with outcomes updated at each time point.Results:Study included 421 participants: 66% were female, with a mean(sd) age 56 (14); 72% were seropositive and 90% were treated with MTX ± csDMARDs as initial therapy. NAP at baseline was common (55%), with majority (62%) reporting regional NAP. NAP prevalence was 33% at 12 months (Figure). Female sex and baseline depressive symptoms were independent predictors of widespread NAP at 12 months while poorer function and lack of early MTX treatment independently predicted regional NAP, at 12 mos. Regional and widespread NAP were associated with lower likelihood of remission in adjusted models that accounted for changes in NAP and remission over time (Table).Figure.Point prevalence of regional and widespread NAP at baseline, 6 and 12 months.Table .Results of Multi-Adjusted GEE Logistic Regression showing Regional and Widespread NAP is associated with a reduced likelihood of achieving Stringent Remission TargetsConclusion:NAP is commonly reported in early RA pts seen in real world settings. Regional NAP was more common than WSP at all time-points, but both NAP patterns were associated lower odds of achieving remission targets by 12 months. These data support considering the role of NAP when assessing RA treatment efficacy during clinical visits and warrant different treatment approaches to reduce symptoms in RA patients receiving target-based care.Disclosure of Interests:Vivian Bykerk: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, LillyPharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie
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Schieir O, Bartlett SJ, Valois MF, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Pope J, Thorne C, Tin D, Bykerk V. SAT0053 ESTIMATING REAL-WORLD UNMET NEEDS FOR REACHING REMISSION IN THE FIRST YEAR FOLLOWING EARLY RA DIAGNOSIS: RESULTS FROM THE CANADIAN EARLY ARTHRITIS COHORT (CATCH). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Several composite RA disease activity indices are commonly used in clinical practice and research. Different disease activity indices however can be inconsistent in classifying remission (REM).Objectives:1) Compare remission prevalence across 4 common RA indices; 2) compare changes in remission across indices; and, 3) Identify predictors of persistent active disease across all indices, in real-world early RA patients over 1 year follow up.Methods:Data were from patients with early RA (symptoms < 1 year) enrolled in the Canadian Early Arthritis Cohort (CATCH) between 2007 and 2018. Participants had active disease at enrolment, were treated with csDMARDs and completed standardized clinical assessments every 3-months. Remission status was assessed using 4 indices: 1) DAS28< 2.6 OR DAS28CRP < 2.5, 2) CDAI ≤ 2.8, 3) SDAI≤ 3.3, and 4) ACR/EULAR Boolean remission – SJC28, TJC28, CRP, PGA all ≦1. T-tests/ chi-squared tests were used to compare differences in remission prevalence by 1 year, and changes in remission before and after a QI program. Logistic regression was used to identify predictors of persistent active disease on all 4 indices.Results:1202 adults were eligible for this analysis. At enrolment, 877 (73%) were women, mean (sd) age was 55 (14), average disease activity was high (DAS28 5.1 (1.4); CDAI 27 (14); SDAI 29 (15)). Prevalence of remission by 12-months follow up was 14-21% higher when estimated with the DAS28 compared with CDAI, SDAI and Boolean criteria, and 378 (31%) did not achieve remission according to any of the 4 indices (Fig 1). Improvement in remission after a QI program however was similar across all 4 indices(~+15-17%). In adjusted logistic regression, Persistent active disease across all measures was most strongly associated with positive serostatus and smoking in men, and with obesity and more tender joints in women. Pain and lower education were predictors in BOTH men and women (Table 2)Table 1.Multivariable Logistic Regression Predicting Persistent Active Disease by 12-months across ALL RA indicesConclusion:In the absence of a single “best measure” that also takes in to account the patient’s perspective, we estimate unmet needs for achieving remission in the first year of follow up in 1 in 3 ERA patients who did not achieve remission by ANY of the 4 indices.References:[1] Kuriya B, Sun Y, Boire G, Haraoui B, etal. Remission in Early Rheumatoid Arthritis – A Comparison of New ACR/EULAR Remission Criteria to Established Criteria.J Rheumatol2012;39:1155-1158.Disclosure of Interests:Orit Schieir: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Marie-France Valois: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, LillyPharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Diane Tin: None declared, Vivian Bykerk: None declared
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Fatima S, Schieir O, Valois MF, Bartlett SJ, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne C, Bykerk V, Pope J. FRI0037 ALL-CAUSE MORTALITY IN EARLY RHEUMATOID ARTHRITIS PREDICTED BY HEALTH ASSESSMENT QUESTIONNAIRE AT ONE YEAR. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Patients with RA are at greater risk of mortality than the general population. Higher HAQ disability has been associated with hospitalizations and mortality in established RA; whether HAQ disability predicts mortality in early RA (ERA) is unknown.Objectives:The objective of this study is to analyze how well the HAQ can predict future mortality in patients with early RA.Methods:Data were from adult early RA patients (symptoms <1 year) enrolled in the Canadian Early Arthritis Cohort (CATCH) between 2007 and 2017; who initiated treatment with 1 or more DMARDs and had completed HAQ data at baseline and 1 year. Descriptive statistics, t-tests and chi-square tests were used to summarize and compare baseline patient characteristics including sociodemographic variables, RA characteristics and comorbidities amongst deceased and non-deceased patients. Discrete-time proportional hazards models were used to estimate crude and multi-adjusted associations between HAQ at baseline and 1 year, respectively, with all-cause mortality in each year of follow up.Results:This study included 1724 patients with early RA; mean age was 55 years and 72% were female. In 10 years of follow up, 62 deaths (2.4%) occurred. Deceased patients had higher HAQ scores and DAS28 scores at baseline and at 1 year versus the non-deceased group. Age, male sex, lower education, smoking, more comorbidities, higher baseline disease activity and steroid use were associated with mortality in unadjusted survival models (Table 1). Contrary to HAQ at baseline, the association between all-cause mortality and HAQ at 1 year remained significant even after adjusting for age, gender, comorbidities, disease activity, smoking, education, seropositivity, symptom duration and steroid use in adjusted survival models (Table 2).Table 1.Unadjusted survival model: Association of each variable with all-cause mortalityBaseline VariableUnadjustedHazard OR95% CISocio-DemographicAge (years)1.101.07 – 1.13Female0.370.22 – 0.62Caucasian (white or European)1.010.46 – 2.24Aboriginal1.710.61 – 4.76Education > high school degree0.480.28 – 0.82Current Smoker1.811.01 – 3.24Rheumatic Disease Comorbidity Index (0-9)1.601.36 – 1.87RA CharacteristicsSymptom duration (months)0.990.91 – 1.08Seropositivity in first year1.110.55 – 2.23DAS28 ESR or CRP if ESR is missing1.261.06 – 1.51Oral Steroid use1.751.03 – 2.98Table 2.Multivariable discrete-time survival models: HAQ baseline vs 1 yearModelModel 1:Crude(Time + HAQ-DI)Model 2:Adjusted for age + sexModel 3:Adjusted for Model 2 + DAS28 + RDCIModel 4:Adjusted for Model 3 + education, smoking, seropositivity, symptom duration and oral steroids useModel 5:Adjusted for Model 3 + smoking, symptom duration onlyHAQ-DI (0-3) (at baseline)1.461.02 – 2.091.370.96 – 1.951.250.81 – 1.941.320.85 – 2.041.300.84 – 2.00HAQ-DI (0-3) (at 1 year)2.581.78 – 3.722.401.63 – 3.521.751.10 – 2.771.871.16 – 3.021.731.09 – 2.74*Hazard OR, 95% CI~HAQ-DI: (Health Assessment Questionnaire Disability Index); RDCI: Rheumatic Disease Comorbidity Index; DAS28: Disease Activity ScoreConclusion:Higher HAQ at 1 year was significantly associated with all-cause mortality in a large early RA cohort suggesting that poorer disease control and function in the first year of RA contributes to higher mortality.Disclosure of Interests:Safoora Fatima: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, LillyPharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Vivian Bykerk: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB
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Petkovic J, Riddle A, Akl EA, Khabsa J, Lytvyn L, Atwere P, Campbell P, Chalkidou K, Chang SM, Crowe S, Dans L, Jardali FE, Ghersi D, Graham ID, Grant S, Greer-Smith R, Guise JM, Hazlewood G, Jull J, Katikireddi SV, Langlois EV, Lyddiatt A, Maxwell L, Morley R, Mustafa RA, Nonino F, Pardo JP, Pollock A, Pottie K, Riva J, Schünemann H, Simeon R, Smith M, Stein AT, Synnot A, Tufte J, White H, Welch V, Concannon TW, Tugwell P. Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation. Syst Rev 2020; 9:21. [PMID: 32007104 PMCID: PMC6995157 DOI: 10.1186/s13643-020-1272-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/06/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Stakeholder engagement has become widely accepted as a necessary component of guideline development and implementation. While frameworks for developing guidelines express the need for those potentially affected by guideline recommendations to be involved in their development, there is a lack of consensus on how this should be done in practice. Further, there is a lack of guidance on how to equitably and meaningfully engage multiple stakeholders. We aim to develop guidance for the meaningful and equitable engagement of multiple stakeholders in guideline development and implementation. METHODS This will be a multi-stage project. The first stage is to conduct a series of four systematic reviews. These will (1) describe existing guidance and methods for stakeholder engagement in guideline development and implementation, (2) characterize barriers and facilitators to stakeholder engagement in guideline development and implementation, (3) explore the impact of stakeholder engagement on guideline development and implementation, and (4) identify issues related to conflicts of interest when engaging multiple stakeholders in guideline development and implementation. DISCUSSION We will collaborate with our multiple and diverse stakeholders to develop guidance for multi-stakeholder engagement in guideline development and implementation. We will use the results of the systematic reviews to develop a candidate list of draft guidance recommendations and will seek broad feedback on the draft guidance via an online survey of guideline developers and external stakeholders. An invited group of representatives from all stakeholder groups will discuss the results of the survey at a consensus meeting which will inform the development of the final guidance papers. Our overall goal is to improve the development of guidelines through meaningful and equitable multi-stakeholder engagement, and subsequently to improve health outcomes and reduce inequities in health.
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Affiliation(s)
- Jennifer Petkovic
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose Ave East, Ottawa, Ontario, Canada.
| | - Alison Riddle
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose Ave East, Ottawa, Ontario, Canada
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | | | - Pearl Atwere
- Bruyère Research Institute, 85 Primrose Ave East, Ottawa, Ontario, Canada
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Kalipso Chalkidou
- Faculty of Medicine, School of Public Health Imperial College, London, UK
| | | | | | - Leonila Dans
- Department of Clinical Epidemiology, University of the Philippines-Manila, Taft Ave, 1000, Manila, Philippines
| | | | - Davina Ghersi
- National Health and Medical Research Council, Canberra, Australia
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sean Grant
- Department of Social & Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, RG 6046, Indianapolis, IN, 46202, USA
| | | | - Jeanne-Marie Guise
- Departments of Obstetrics and Gynecology, Medical Informatics & Clinical Epidemiology, Emergency Medicine Oregon Health & Science, University School of Medicine and the OHSU-PSU School of Public Health, Portland, USA
| | | | - Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - S Vittal Katikireddi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK
| | - Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Anne Lyddiatt
- Cochrane Musculoskeletal Group, London, Ontario, Canada
| | | | - Richard Morley
- The Cochrane Collaboration, Cochrane Consumer Network, London, UK
| | - Reem A Mustafa
- Department of Internal Medicine/Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas, USA
| | - Francesco Nonino
- Unit of Epidemiology and Statistics, IRCCS - Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Jordi Pardo Pardo
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Alex Pollock
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Kevin Pottie
- Departments of Family Medicine and Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Primary Care Research Group and Equity Methods Group, Bruyère Research Institute, Ottawa, Canada
| | - John Riva
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, Cochrane Canada and McMaster GRADE Centre, Hamilton, Canada
| | - Rosiane Simeon
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose Ave East, Ottawa, Ontario, Canada
| | - Maureen Smith
- Cochrane Consumer Executive, Ottawa, Ontario, Canada
| | - Airton T Stein
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Rua Sarmento Leite 245, Porto Alegre, RS, 90050-170, Brazil
| | - Anneliese Synnot
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Howard White
- Alfred Deakin University, Geelong, Australia.,Journal of Development Studies and Journal of Development Effectiveness, Geelong, Victoria, Australia
| | - Vivian Welch
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose Ave East, Ottawa, Ontario, Canada.,The Campbell Collaboration, Oslo, Norway
| | - Thomas W Concannon
- The RAND Corporation, Boston, MA, USA.,Tufts Clinical & Translational Science Institute, Tufts University School of Medicine, Boston, MA, USA
| | - Peter Tugwell
- University of Ottawa, Department of Medicine, Faculty of Medicine, Ottawa, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada.,University of Ottawa, School of Epidemiology and Public Health, Faculty of Medicine, Ottawa, Canada
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