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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 PMCID: PMC11089442 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 CanadaVancouverBritish ColumbiaCanada
| | - Glen Hazlewood
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | | | | | - Karen L. Then
- Alberta Health Services and University of CalgaryCalgaryAlbertaCanada
| | - Erika Dempsey
- Alberta Health Services and University of CalgaryCalgaryAlbertaCanada
| | - Richard Lester
- University of British Columbia and WelTel IncVancouverBritish ColumbiaCanada
| | - Alison M. Hoens
- Arthritis Research Canada and University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Diane Lacaille
- Arthritis Research Canada and University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cheryl Barnabe
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | - James Rankin
- University of Calgary, Calgary, Alberta, Canada, and Thompson Rivers UniversityKamloopsBritish ColumbiaCanada
| | - Dianne Mosher
- Alberta Health Services and University of CalgaryCalgaryAlbertaCanada
| | - Claire E. H. Barber
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research CanadaVancouverBritish ColumbiaCanada
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Bowdish DME, Chandran V, Hitchon CA, Kaplan GG, Avina-Zubieta JA, Fortin PR, Larché MJ, Boire G, Gingras AC, Dayam RM, Colmegna I, Lukusa L, Lee JLF, Richards DP, Pereira D, Watts TH, Silverberg MS, Bernstein CN, Lacaille D, Benoit J, Kim J, Lalonde N, Gunderson J, Allard-Chamard H, Roux S, Quan J, Hracs L, Turnbull E, Valerio V, Bernatsky S. When Should I Get My Next COVID Vaccine? Data from the SUrveillance of responses to COVID-19 vaCcines in systEmic immunE mediated inflammatory Diseases (SUCCEED)study. J Rheumatol 2024:jrheum.2023-1214. [PMID: 38621797 DOI: 10.3899/jrheum.2023-1214] [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: 04/17/2024]
Abstract
OBJECTIVE To determine how serologic responses to COVID vaccination/infection in immunemediated inflammatory disease (IMID) are affected by time since last vaccination and other factors. METHODS Post-COVID-19 vaccination, data and dried blood spots/sera were collected from adults with rheumatoid arthritis, inflammatory bowel disease, systemic lupus, ankylosing spondylitis/spondylarthritis and psoriasis/psoriatic arthritis. First sample was at enrolment and then 2-4 weeks and 3, 6, and 12 months after latest vaccine dose. Multivariate generalized estimating equation regressions (including medications, demographics, and vaccination history) evaluated serologic response, based on log-transformed anti-RBD IgG titres; we also measured anti-nucleocapsid IgG. RESULTS Positive associations for log-transformed anti-RBD titres were seen with female sex, number of doses, and self-reported COVID infections in 2021-2023. Negative associations were seen with prednisone, anti-TNF agents, and rituximab.Over 2021-2023, most (94%) of anti-nucleocapsid positivity was associated with a self-reported infection in the 3 months prior. From March 2021 to Feb 2022, anti-nucleocapsid positivity was present in 5-15% of samples and was highest in the post-Omicron era, with anti-nucleocapsid positivity trending to 30-35% or higher as of March 2023. Anti-nucleocapsid positivity in IMID remained lower than Canada's general population seroprevalence (>50% in 2022 and >75% in 2023).Time since last vaccination was negatively associated with log-transformed anti-RBD titres, particularly after 210 days. CONCLUSION Ours is the first pan-Canadian IMID assessment of how vaccine history and other factors affect serologic COVID-19 vaccine responses. These findings may help individuals personalize vaccination decisions, including consideration of additional vaccination when >6 months has elapsed since last COVID vaccination/infection.
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Affiliation(s)
- Dawn M E Bowdish
- Dawn ME Bowdish PhD, Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - Vinod Chandran
- Vinod Chandran MD PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carol A Hitchon
- Carol A Hitchon MD MSc, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gilaad G Kaplan
- Gilaad G. Kaplan MD MPH, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - J Antonio Avina-Zubieta
- J. Antonio Avina-Zubieta MD PhD, Arthritis Research Canada and Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul R Fortin
- Paul R Fortin MD MPH, Centre de Recherche Arthrite, Division of Rheumatology, Department of Medicine, CHU de Québec - Université Laval, Québec City, Québec, Canada
| | - Maggie J Larché
- Maggie J. Larché MD PhD, Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gilles Boire
- Gilles Boire MD MSc, Division of Rheumatology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne-Claude Gingras
- Anne-Claude Gingras PhD, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Roya M Dayam
- Roya M Dayam PhD, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Ines Colmegna
- Ines Colmegna MD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Medicine, Division of Rheumatology, McGill University, Montreal, Quebec, Canada
| | - Luck Lukusa
- Luck Lukusa MSc, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Jennifer L F Lee
- Jennifer LF Lee BSc, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Dawn P Richards
- Dawn P Richards PhD, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Daniel Pereira
- Daniel Pereira BSc, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Tania H Watts
- Tania H Watts PhD, Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Silverberg
- Mark S Silverberg MD PhD, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada; Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, Sinai Health, Ontario, Canada
| | - Charles N Bernstein
- Charles N Bernstein MD, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Diane Lacaille
- Diane Lacaille MD MHSc, Arthritis Research Canada and Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jenna Benoit
- Jenna Benoit, Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - John Kim
- John Kim PhD, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Nadine Lalonde
- Nadine Lalonde BSc, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Janet Gunderson
- Janet Gunderson BEd, Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Hugues Allard-Chamard
- Hugues Allard-Chamard MD PhD, Division of Rheumatology , Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sophie Roux
- Sophie Roux MD PhD, Division of Rheumatology , Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Joshua Quan
- Joshua Quan MSc, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lindsay Hracs
- Lindsay Hracs PhD, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Turnbull
- Elizabeth Turnbull RN, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Valeria Valerio
- Valeria Valerio MD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Sasha Bernatsky
- Sasha Bernatsky MD PhD, The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Medicine, Division of Rheumatology, McGill University, Montreal, Quebec, Canada
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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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4
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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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Hoque MR, Aviña-Zubieta JA, Lacaille D, De Vera MA, Qian Y, McCandless L, Esdaile JM, Xie H. Antimalarial Adherence and Risk of Cardiovascular Events in Patients With Rheumatoid Arthritis and Systemic Lupus Erythematosus: A Population-Based Study. Arthritis Care Res (Hoboken) 2024; 76:426-436. [PMID: 37691305 DOI: 10.1002/acr.25233] [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: 03/05/2023] [Revised: 08/21/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE We aimed to assess the association between antimalarial adherence and cardiovascular events between incident rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) population-based cohorts. METHODS All patients with incident RA/SLE and incident antimalarial use in British Columbia, Canada, between January 1997 and March 2015 were identified using provincial administrative databases. The outcomes were incident cardiovascular events, including myocardial infarction (MI), stroke, or venous thromboembolism (VTE). The exposure was antimalarial adherence with levels: discontinuation (proportion of days covered [PDC = 0]), nonadherence (0 < PDC < 0.90), and adherence (PDC ≥ 0.90). We used marginal structural models to estimate the effect of antimalarial adherence on the rate of cardiovascular events, accounting for potential confounders. RESULTS We identified 16,538 individuals with incident RA/SLE and incident antimalarial use without any cardiovascular event before the index date. Over nine years mean follow-up, 2,174 incident cardiovascular events (13.2%) were observed. The adjusted hazard ratio (aHR) for incident cardiovascular events for antimalarial adherence relative to discontinuation was 0.72 (95% confidence interval [CI] 0.64-0.81) and 1.01 (95% CI 0.90-1.14) for nonadherence. Additionally, the aHRs for all cardiovascular events, MI, stroke, and VTE for adherence relative to nonadherence was 0.71 (95% CI 0.61-0.82), 0.62 (95% CI 0.51-0.75), 0.45 (95% CI 0.36-0.58), and 0.65 (95% CI 0.46-0.93), respectively. We found older age modified the association between antimalarial adherence and cardiovascular events (P = 0.02). CONCLUSION When people newly diagnosed with RA or SLE take their antimalarial regularly as prescribed (PDC ≥ 0.90), they have a 29% lower risk of sustaining a cardiovascular event than patients with a lower degree of adherence (PDC < 0.90) and a 28% lower risk than if they discontinue antimalarials.
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Affiliation(s)
- Md Rashedul Hoque
- Arthritis Research Canada, Vancouver, and Simon Fraser University, Burnaby, British Columbia, Canada
| | - J Antonio Aviña-Zubieta
- 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
| | - Mary A De Vera
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Yi Qian
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John M Esdaile
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, and Simon Fraser University, Burnaby, British Columbia, Canada
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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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Hassen N, Lacaille D, Xu A, Alandejani A, Sidi S, Mansourian M, Butt ZA, Cahill LE, Iyamu IO, Lang JJ, Rana J, Somayaji R, Sarrafzadegan N, Kopec JA. National burden of rheumatoid arthritis in Canada, 1990-2019: findings from the Global Burden of Disease Study 2019 - a GBD collaborator-led study. RMD Open 2024; 10:e003533. [PMID: 38216285 PMCID: PMC10806499 DOI: 10.1136/rmdopen-2023-003533] [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: 07/25/2023] [Accepted: 12/12/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE The objectives of this study were: (1) to describe burden of rheumatoid arthritis (RA) and trends from 1990 to 2019 using the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) data, (2) to describe age and sex differences in RA and (3) to compare Canada's RA burden to that of other countries. METHODS Disease burden indicators included prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life-years (DALYs). GBD estimated fatal and non-fatal outcomes using published literature, survey data and health insurance claims. Data were analysed by Bayesian meta-regression, cause of death ensemble model and other statistical methods. DALYs for Canada were compared with DALYs of countries with similarly high Socio-Demographic Index values. RESULTS In Canada, the RA prevalence rate increased by 27% between 1990 and 2019, mortality rate decreased by 27%, YLL rate decreased by 30%, YLD increased by 27% and DALY rate increased by 13%, all age standardised. The decline in RA mortality and YLL rates was especially pronounced after 2002. The disease burden was higher in females for all indicators, and DALY rates were higher among older age groups, peaking at age 75-79 years. Prevalence and DALYs were higher in Canada compared with global rates. CONCLUSION Trends in RA burden indicators over time and differences by age and sex have important implications for Canadian policy-makers, researchers and care providers. Early identification and management of RA in women may help reduce the overall burden of RA in Canada.
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Affiliation(s)
- Nejat Hassen
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Xu
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Amani Alandejani
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sophia Sidi
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Marjan Mansourian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahid A Butt
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Al Shifa School of Public Health, Al-Shifa Trust Eye Hospital Rawalpindi, Rawalpindi, Pakistan
| | - Leah E Cahill
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Nutrition, Harvard University, Boston, Massachusetts, USA
| | - Ihoghosa Osamuyi Iyamu
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Knowledge Translation Program, Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Justin J Lang
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Juwel Rana
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Research and Innovation Division, South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh
| | - Ranjani Somayaji
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Nizal Sarrafzadegan
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Isfahan Cardiovascular Research Institute, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jacek A Kopec
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
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9
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Karacabeyli D, Lacaille D. Glucagon-Like Peptide 1 Receptor Agonists in Patients With Inflammatory Arthritis or Psoriasis: A Scoping Review. J Clin Rheumatol 2024; 30:26-31. [PMID: 36870080 DOI: 10.1097/rhu.0000000000001949] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
ABSTRACT Obesity is a proinflammatory state associated with increased disease severity in various types of inflammatory arthritis. Weight loss is associated with improved disease activity in certain forms of inflammatory arthritis such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA). We conducted a scoping review summarizing the literature evaluating the effect of glucagon-like peptide 1 (GLP-1) receptor agonists on weight and disease activity in patients with inflammatory arthritis or psoriasis. MEDLINE, PubMed, Scopus, and Embase were searched for publications evaluating the role of GLP-1 analogs in RA, PsA, psoriasis, axial spondyloarthritis, systemic lupus erythematosus, systemic sclerosis, gout, and calcium pyrophosphate deposition disease. Nineteen studies were included: 1 gout study, 5 RA studies (3 basic science, 1 case report, and 1 longitudinal cohort), and 13 psoriasis studies (2 basic science, 4 case reports, 2 combined basic science/clinical studies, 3 longitudinal cohorts, and 2 randomized controlled trials). No psoriasis study reported on PsA outcomes. Basic science experiments demonstrated weight-independent immunomodulatory effects of GLP-1 analogs through inhibition of the NF-κB pathway (via AMP-activated protein kinase phosphorylation in psoriasis and prevention of IκBα phosphorylation in RA). In RA, improved disease activity was reported. In psoriasis, 4 of 5 clinical studies demonstrated significant improvements in Psoriasis Area Severity Index and weight/body mass index with no major adverse events. Common limitations included small sample sizes, short follow-up periods, and lack of control groups. GLP-1 analogs safely cause weight loss and have potential weight-independent anti-inflammatory effects. Their role as an adjunct in patients with inflammatory arthritis and obesity or diabetes is understudied, warranting future research.
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Affiliation(s)
- Derin Karacabeyli
- From the Division of Rheumatology, Department of Medicine, University of British Columbia
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, British Columbia, Canada
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10
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Li LC, Xie H, Feehan LM, Shaw C, Lu N, Ramachandran S, Wang E, Therrien S, Mucha J, Hoens AM, English K, Davidson E, Liu-Ambrose T, Backman CL, Esdaile JM, Miller KJ, Lacaille D. Effect of digital monitoring and counselling on self-management ability in patients with rheumatoid arthritis: a randomised controlled trial. Rheumatology (Oxford) 2023:kead709. [PMID: 38152927 DOI: 10.1093/rheumatology/kead709] [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: 10/09/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES To assess a remote physiotherapist (PT) counselling intervention using self-monitoring tools for improving self-management ability, physical activity participation, and health outcomes in people with rheumatoid arthritis (RA). METHODS Eligible participants were randomly assigned to receive group education, a Fitbit®, a self-monitoring app, and PT counselling phone calls (Immediate Group). The Delayed Group received a monthly e-newsletter until week 26, and then the intervention. The primary outcome was Patient Activation Measure (PAM-13). Participants were assessed at baseline, 27 weeks (the primary end point) and 53 weeks. Secondary outcomes included disease activity, pain, fatigue, depression, sitting/walking habits, daily physical activity time, and daily awake sedentary time. Generalized Linear Mixed-effect Models (GLMMs) were used to assess the effect of the intervention on the change of each outcome measure from the initiation to 27 weeks after the intervention. RESULTS Analysis included 131 participants (91.6% women; 80.2% completed during the COVID-19 pandemic). The mean change of PAM-13 at 27 weeks was 4.6 (SD = 14.7) in the Immediate Group vs -1.6 (SD = 12.5) in the Delayed Group. The mean change in Delayed Group at 53 weeks (after the 26-week intervention) was 3.6 (SD = 14.6). Overall, the intervention improved PAM-13 at 27 weeks post-intervention from the GLMM analysis (adjusted coefficient: 5.3; 95% CI: 2.0, 8.7; p = <0.001). Favourable intervention effects were also found in disease activity, fatigue, depression, and self-reported walking habit. CONCLUSION Remote counselling paired with self-monitoring tools improved self-management ability in people with RA. Findings of secondary outcomes indicate that the intervention had a positive effect on symptom management.
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Affiliation(s)
- Linda C Li
- Department of Physical Therapy, University of British Columbia, Wesbrook Mall, Vancouver BC, 212-2177, Canada
| | - Hui Xie
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive Burnaby, BC, Canada
| | - Lynne M Feehan
- Department of Physical Therapy, University of British Columbia, Wesbrook Mall, Vancouver BC, 212-2177, Canada
| | - Chris Shaw
- School of Interactive Arts and Technology, Simon Fraser University, 102 Avenue Surrey BC, 250-13450, Canada
| | - Na Lu
- Arthritis Research Canada, Yukon Street, Vancouver, BC, 230-2238, Canada
| | - Smruthi Ramachandran
- Department of Physical Therapy, University of British Columbia, Wesbrook Mall, Vancouver BC, 212-2177, Canada
| | - Ellen Wang
- Department of Physical Therapy, University of British Columbia, Wesbrook Mall, Vancouver BC, 212-2177, Canada
| | - Stephanie Therrien
- Arthritis Research Canada, Yukon Street, Vancouver, BC, 230-2238, Canada
| | - Julia Mucha
- Department of Physical Therapy, University of British Columbia, Wesbrook Mall, Vancouver BC, 212-2177, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Wesbrook Mall, Vancouver BC, 212-2177, Canada
| | - Kelly English
- Arthritis Research Canada, Yukon Street, Vancouver, BC, 230-2238, Canada
| | - Eileen Davidson
- Arthritis Research Canada, Yukon Street, Vancouver, BC, 230-2238, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Wesbrook Mall, Vancouver BC, 212-2177, Canada
| | - Catherine L Backman
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Wesbrook Mall, Vancouver, BC, 325-2211, Canada
| | - John M Esdaile
- Arthritis Research Canada, Yukon Street, Vancouver, BC, 230-2238, Canada
| | - Kimberly J Miller
- New Knowledge and Innovation, BC Children's Hospital and BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, BC, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Yukon Street, Vancouver, BC, 230-2238, Canada
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11
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Zhou VY, Lacaille D, Lu N, Kopec JA, Qian Y, Nosyk B, Aviña-Zubieta JA, Esdaile JM, Xie H. Risk of severe infections after the introduction of biologic DMARDs in people with newly diagnosed rheumatoid arthritis: a population-based interrupted time-series analysis. Rheumatology (Oxford) 2023; 62:3858-3865. [PMID: 37014364 PMCID: PMC10691931 DOI: 10.1093/rheumatology/kead158] [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: 01/10/2023] [Revised: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVES To determine the impact of the introduction of biologic DMARDs (bDMARDs) on severe infections among people newly diagnosed with RA compared with non-RA individuals. METHODS In this population-based retrospective cohort study using administrative data (from 1990-2015) for British Columbia, Canada, all incident RA patients diagnosed between 1995 and 2007 were identified. General population controls with no inflammatory arthritis were matched to RA patients based on age and gender, and were assigned the diagnosis date (i.e. index date) of the RA patients they were matched with. RA/controls were then divided into quarterly cohorts according to their index dates. The outcome of interest was all severe infections necessitating hospitalization or occurring during hospitalization after the index date. We calculated 8-year severe infection rates for each cohort and conducted interrupted time-series analyses to compare severe infection trends in RA/controls with index date during pre-bDMARDs (1995-2001) and post-bDMARDs (2003-2007) periods. RESULTS A total of 60 226 and 588 499 incident RA/controls were identified. We identified 14 245 severe infections in RA, and 79 819 severe infections in controls. The 8-year severe infection rates decreased among RA/controls with increasing calendar year of index date in the pre-bDMARDs period, but increased over time only among RA, not controls, with index date in the post-bDMARDs period. The adjusted difference between the pre- and post-bDMARDs secular trends in 8-year severe infection rates was 1.85 (P = 0.001) in RA and 0.12 (P = 0.29) in non-RA. CONCLUSION RA onset after bDMARDs introduction was associated with an elevated severe infection risk in RA patients compared with matched non-RA individuals.
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Affiliation(s)
- Vivienne Y Zhou
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Na Lu
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Jacek A Kopec
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Division of Epidemiology, Biostatistics and Public Health Practice, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yi Qian
- Sauder School of Business, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
- Center for Health Evaluation & Outcome Sciences, Vancouver, British Columbia, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John M Esdaile
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
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12
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Hoque MR, Xie H, Lacaille D, Esdaile JM, Aviña-Zubieta JA. Reply. Arthritis Rheumatol 2023; 75:2065-2066. [PMID: 37229791 DOI: 10.1002/art.42621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Affiliation(s)
- M Rashedul Hoque
- Arthritis Research Canada Vancouver, Canada and Simon Fraser University, Burnaby, Canada
| | - Hui Xie
- Arthritis Research Canada Vancouver, Canada and Simon Fraser University, Burnaby, Canada
| | - Diane Lacaille
- Arthritis Research Canada and University of British Columbia, Vancouver, Canada
| | - John M Esdaile
- Arthritis Research Canada and University of British Columbia, Vancouver, Canada
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13
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Marozoff S, Tan J, Lu N, Kirmani A, Loree JM, Xie H, Lacaille D, Kopec JA, Esdaile JM, Corradetti B, Malone P, Koehn CL, Mennell P, Hoens AM, Aviña-Zubieta JA. Effect of Immunosuppressive or Immunomodulatory Agents on Severe COVID-19 Outcomes: A Population-Based Cohort Study. ACR Open Rheumatol 2023. [PMID: 37818772 DOI: 10.1002/acr2.11620] [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: 06/12/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE We estimated the association between immunosuppressive and immunomodulatory agent (IIA) exposure and severe COVID-19 outcomes in a population-based cohort study. METHODS Participants were 18 years or older, tested positive for SARS-CoV-2 between February 6, 2020, and August 15, 2021, and were from administrative health data for the entire province of British Columbia, Canada. IIA use within 3 months prior to positive SARS-CoV-2 test included conventional disease-modifying antirheumatic drugs (antimalarials, methotrexate, leflunomide, sulfasalazine, individually), immunosuppressants (azathioprine, mycophenolate mofetil/mycophenolate sodium [MMF], cyclophosphamide, cyclosporine, individually and collectively), tumor necrosis factor inhibitor (TNFi) biologics (adalimumab, certolizumab, etanercept, golimumab, infliximab, collectively), non-TNFi biologics or targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) (rituximab separately from abatacept, anakinra, secukinumab, tocilizumab, tofacitinib and ustekinumab collectively), and glucocorticoids. Severe COVID-19 outcomes were hospitalizations for COVID-19, ICU admissions, and deaths within 60 days of a positive test. Exposure score-overlap weighting was used to balance baseline characteristics of participants with IIA use compared with nonuse of that IIA. Logistic regression measured the association between IIA use and severe COVID-19 outcomes. RESULTS From 147,301 participants, we identified 515 antimalarial, 573 methotrexate, 72 leflunomide, 180 sulfasalazine, 468 immunosuppressant, 378 TNFi biologic, 49 rituximab, 144 other non-TNFi biologic or tsDMARD, and 1348 glucocorticoid prescriptions. Risk of hospitalizations for COVID-19 was significantly greater for MMF (odds ratio [95% CI]): 2.82 [1.81-4.40], all immunosuppressants: 2.08 [1.51-2.87], and glucocorticoids: 1.63 [1.36-1.96], relative to nonuse. Similar outcomes were seen for ICU admission and MMF: 2.52 [1.34-4.74], immunosuppressants: 2.88 [1.73-4.78], and glucocorticoids: 1.86 [1.37-2.54]. Only glucocorticoids use was associated with a significant increase in 60-day mortality: 1.58 [1.21-2.06]. No other IIAs displayed statistically significant associations with severe COVID-19 outcomes. CONCLUSION Current use of MMF and glucocorticoids were associated with an increased risk of severe COVID-19 outcomes compared with nonuse. These results emphasize the variety of circumstances of patients taking IIAs.
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Affiliation(s)
- Shelby Marozoff
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Jeremiah Tan
- Arthritis Research Canada and University of British Columbia, Vancouver, Canada
| | - Na Lu
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Ayesha Kirmani
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | | | - Hui Xie
- Arthritis Research Canada, Vancouver, and Simon Fraser University, Burnaby, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada and University of British Columbia, Vancouver, Canada
| | - Jacek A Kopec
- Arthritis Research Canada and University of British Columbia, Vancouver, Canada
| | - John M Esdaile
- Arthritis Research Canada and University of British Columbia, Vancouver, Canada
| | - Bonnie Corradetti
- Arthritis Research Canada, Vancouver, British Columbia, and Kidney Section of the Medicine Strategic Clinical Network, Alberta Health, Edmonton, Canada
| | - Peter Malone
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Cheryl L Koehn
- Arthritis Research Canada and Arthritis Consumer Experts, Vancouver, British Columbia, Canada
| | | | - Alison M Hoens
- Arthritis Research Canada and University of British Columbia, Vancouver, Canada
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14
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Studenic P, Aletaha D, Stamm TA, de Wit M, Lacaille D, Smolen JS, Felson D. Response to: Correspondence on "Testing different thresholds for patient global assessment in defining remission for rheumatoid arthritis: are the current ACR/EULAR Boolean criteria optimal?" by Boers. Ann Rheum Dis 2023; 82:e202. [PMID: 37080713 DOI: 10.1136/ard-2022-223627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Paul Studenic
- Department of Medicine (Solna), Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Tanja A Stamm
- Center for Medical Statistics, Informatics, and Intelligent Systems, Institute for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Maarten de Wit
- EULAR community of People with Arthritis/Rheumatism in Europe (PARE), Zürich, Switzerland
| | - Diane Lacaille
- Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Josef S Smolen
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - David Felson
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
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15
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Tseng LO, Newton C, Hall D, Lee EJ, Chang H, Poureslami I, Vasarhelyi K, Lacaille D, Mitton C. Primary care family physicians' experiences with clinical integration in qualitative and mixed reviews: a systematic review protocol. BMJ Open 2023; 13:e067576. [PMID: 37433736 DOI: 10.1136/bmjopen-2022-067576] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Clinical (service) integration in primary care settings describes how comprehensive care is coordinated by family physicians (FPs) over time across healthcare contexts to meet patient care needs. To improve care integration and healthcare service planning, a systematic approach to understanding its numerous influencing factors is paramount. The objective of this study is to generate a comprehensive map of FP-perceived factors influencing clinical integration across diseases and patient demographics. METHODS AND ANALYSIS We developed the protocol with the guidance of the Joanna Briggs Institute systematic review methodology framework. An information specialist built search strategies for MEDLINE, EMBASE and CINAHL databases using keywords and MeSH terms iteratively collected from a multidisciplinary team. Two reviewers will work independently throughout the study process, from article selection to data analysis. The identified records will be screened by title and abstract and reviewed in the full text against the criteria: FP in primary care (population), clinical integration (concept) and qualitative and mixed reviews published in 2011-2021 (context). We will first describe the characteristics of the review studies. Then, we will extract qualitative, FP-perceived factors and group them by content similarities, such as patient factors. Lastly, we will describe the types of extracted factors using a custom framework. ETHICS AND DISSEMINATION Ethics approval is not required for a systematic review. The identified factors will help generate an item bank for a survey that will be developed in the Phase II study to ascertain high-impact factors for intervention(s), as well as evidence gaps to guide future research. We will share the study findings with various knowledge users to promote awareness of clinical integration issues through multiple channels: publications and conferences for researchers and care providers, an executive summary for clinical leaders and policy-makers, and social media for the public.
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Affiliation(s)
- L Olivia Tseng
- Department of Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Christie Newton
- Department of Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - David Hall
- Department of Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Department of Family & Community Practice, Vancouver Coastal Health Authority (VCHA), Vancouver, British Columbia, Canada
| | - Esther J Lee
- Complex Care Program, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Pediatrics, Division of General Pediatrics, UBC, Vancouver, British Columbia, Canada
| | - Howard Chang
- Department of Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Iraj Poureslami
- Respiratory Medicine Division, University of British Columbia, Vancouver, British Columbia, Canada
| | - Krisztina Vasarhelyi
- Department of Family & Community Practice, Vancouver Coastal Health Authority (VCHA), Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Craig Mitton
- Centre for Clinical Epidemiology and Evaluation (C2E2), Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
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16
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Jorge A, Lu N, Choi H, Esdaile JM, Lacaille D, Avina-Zubieta JA. Hydroxychloroquine Use and Cardiovascular Events Among Patients With Systemic Lupus Erythematosus and Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:743-748. [PMID: 34941008 PMCID: PMC9218009 DOI: 10.1002/acr.24850] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/18/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We evaluated the potential temporal association between hydroxychloroquine (HCQ) use and cardiovascular (CV) events among patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). METHODS We conducted a nested case-control study within inception cohorts of SLE and RA patients using administrative health databases including the entire population of British Columbia, Canada. We identified cases with incident CV events, including myocardial infarction (MI), stroke, or venous thromboembolism (VTE). We matched each case with up to 3 controls on age, sex, and rheumatic disease. HCQ exposure was categorized by the time between the last HCQ prescription date covered and the index date as current use, recent use, remote use, or never used. We used conditional logistic regression to assess the association between HCQ exposure and CV events, using remote use as the reference group. RESULTS We identified 10,268 cases and 29,969 controls. Adjusted conditional odd ratios (cORs) and 95% confidence intervals (95% CIs) for current HCQ use relative to remote use were 0.86 (0.77-0.97) for combined CV events, 0.88 (0.74-1.05) for MI, 0.87 (0.74-1.03) for stroke, and 0.74 (0.59-0.94) for VTE. Recent HCQ users and nonusers had similar odds of combined CV events as remote users (cORs 0.93, 95% CI 0.77-1.13 and 0.96, 95% CI 0.88-1.04, respectively). CONCLUSION In this nested case-control study of patients with SLE and RA, we found a reduced risk of overall CV events associated with current HCQ use, including reductions in VTE and trends toward reductions in MI and stroke. These findings suggest a possible cardiovascular preventative benefit of HCQ use.
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Affiliation(s)
- April Jorge
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital
| | - Na Lu
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital
- Arthritis Research Canada, Richmond, BC, Canada
| | - Hyon Choi
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital
| | - John M. Esdaile
- Arthritis Research Canada, Richmond, BC, Canada
- Divison of Rheumatology, University of British Columbia,
Vancouver, BC, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Richmond, BC, Canada
- Divison of Rheumatology, University of British Columbia,
Vancouver, BC, Canada
| | - J. Antonio Avina-Zubieta
- Arthritis Research Canada, Richmond, BC, Canada
- Divison of Rheumatology, University of British Columbia,
Vancouver, BC, Canada
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17
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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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18
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Barber CEH, Lacaille D, Croxford R, Barnabe C, Marshall DA, Abrahamowicz M, Xie H, Aviña-Zubieta JA, Esdaile JM, Hazlewood GS, Faris P, Katz S, MacMullan P, Mosher D, Widdifield J. Investigating Associations Between Access to Rheumatology Care, Treatment, Continuous Care, and Healthcare Utilization and Costs Among Older Individuals With Rheumatoid Arthritis. J Rheumatol 2023; 50:617-624. [PMID: 36642438 DOI: 10.3899/jrheum.220729] [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] [Accepted: 11/14/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To examine the association between rheumatologist access, early treatment, and ongoing care of older-onset rheumatoid arthritis (RA) and healthcare utilization and costs following diagnosis. METHODS We analyzed data from a population-based inception cohort of individuals aged > 65 years with RA in Ontario, Canada, diagnosed between 2002 and 2014 with follow-up to 2019. We assessed 4 performance measures in the first 4 years following diagnosis, including access to rheumatology care, yearly follow-up, timely treatment, and ongoing treatment with a disease-modifying antirheumatic drug. We examined annual healthcare utilization, mean direct healthcare costs, and whether the performance measures were associated with costs in year 5. RESULTS A total of 13,293 individuals met inclusion criteria. The mean age was 73.7 (SD 5.7) years and 68% were female. Total mean direct healthcare cost per individual increased annually and was CAD $13,929 in year 5. All 4 performance measures were met for 35% of individuals. In multivariable analyses, costs for not meeting access to rheumatology care and timely treatment performance measures were 20% (95% CI 8-32) and 6% (95% CI 1-12) higher, respectively, than where those measures were met. The main driver of cost savings among individuals meeting all 4 performance measures were from lower complex continuing care, home care, and long-term care costs, as well as fewer hospitalizations and emergency visits. CONCLUSION Access to rheumatologists for RA diagnosis, timely treatment, and ongoing care are associated with lower total healthcare costs at 5 years. Investments in improving access to care may be associated with long-term health system savings.
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Affiliation(s)
- Claire E H Barber
- C.E.H. Barber, MD, PhD, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Diane Lacaille
- D. Lacaille, MD, MHSc,, Department of Medicine, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia
| | | | - Cheryl Barnabe
- C. Barnabe, MD, MSc, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Deborah A Marshall
- D.A. Marshall, PhD, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Michal Abrahamowicz
- M. Abrahamowicz, PhD, Department of Epidemiology & Biostatistics, McGill University, Montreal, Quebec, and Arthritis Research Canada, Vancouver, British Columbia
| | - Hui Xie
- H. Xie, PhD, Faculty of Health Sciences, Simon Fraser University, Burnaby, and Arthritis Research Canada, Vancouver, British Columbia
| | - J Antonio Aviña-Zubieta
- J.A. Aviña-Zubieta, MD, PhD, Department of Medicine, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia
| | - John M Esdaile
- J.M. Esdaile, MD, MPH, Department of Medicine, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia
| | - Glen S Hazlewood
- G.S. Hazlewood, MD, PhD, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia
| | - Peter Faris
- P. Faris, PhD, Alberta Health Services, Calgary, Alberta
| | - Steven Katz
- S. Katz, MD, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Paul MacMullan
- P. MacMullan, MB BCh BAO, MRCPI, MD, Department of Medicine, University of Calgary, Calgary, Alberta
| | - Dianne Mosher
- D. Mosher MD, Department of Medicine, University of Calgary, Calgary, Alberta
| | - Jessica Widdifield
- J. Widdifield, PhD, Holland Bone & Joint Program, Sunnybrook Research Institute, and ICES, and Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
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19
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Studenic P, Aletaha D, de Wit M, Stamm TA, Alasti F, Lacaille D, Smolen JS, Felson DT. American College of Rheumatology/EULAR Remission Criteria for Rheumatoid Arthritis: 2022 Revision. Arthritis Rheumatol 2023; 75:15-22. [PMID: 36274193 PMCID: PMC10092655 DOI: 10.1002/art.42347] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 04/13/2022] [Revised: 08/10/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In 2011, the American College of Rheumatology (ACR) and EULAR endorsed provisional criteria for remission in rheumatoid arthritis (RA), both Boolean- and index-based. Based on recent studies indicating that a higher threshold for the patient global assessment (PtGA) may improve agreement between the 2 sets of criteria, our goals were to externally validate a revision of the Boolean remission criteria using a higher PtGA threshold and to validate the provisionally endorsed index-based criteria. METHODS We used data from 4 randomized trials comparing biologic disease-modifying antirheumatic drugs to methotrexate or placebo. We tested the higher proposed PtGA threshold of 2 cm (Boolean2.0) (range 0-10 cm) compared to the original threshold of 1 cm (Boolean1.0). We analyzed agreement between the Boolean- and index-based criteria (Simplified Disease Activity Index [SDAI] and Clinical Disease Activity Index [CDAI]) for remission and examined how well each remission definition predicted later good physical function (Health Assessment Questionnaire [HAQ] score ≤0.5) and radiographic nonprogression. RESULTS Data from 2,048 trial participants, 1,101 with early RA and 947 with established RA, were included. The proportion of patients with disease in remission at 6 months after treatment initiation increased when using Boolean2.0 compared to Boolean1.0, from 14.8% to 20.6% in early RA and 4.2% to 6.0% in established RA. Agreement between Boolean2.0 and the SDAI or CDAI remission criteria was better than for Boolean1.0, particularly in early disease. Boolean2.0, SDAI, and CDAI remission criteria had similar positive likelihood ratios (LRs) to predict radiographic nonprogression and a HAQ score of ≤0.5 (positive LR 3.8-4.3). The omission of PtGA (BooleanX) worsened the prediction of good functional outcomes. CONCLUSION Using the Boolean 2.0 criteria classifies more patients as achieving remission and increases the agreement with index-based remission criteria without jeopardizing predictive value for radiographic or functional outcomes. This revised Boolean definition and the previously provisionally endorsed index-based criteria were endorsed by ACR and EULAR.
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Affiliation(s)
- Paul Studenic
- Division of Rheumatology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden, and Division of Rheumatology, Department of Internal Medicine 3, Medical University of ViennaViennaAustria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine 3Medical University of ViennaViennaAustria
| | - Maarten de Wit
- EULAR Community of People with Arthritis/Rheumatism in Europe (PARE)ZürichSwitzerland
| | - Tanja A. Stamm
- Institute for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent SystemsMedical University of ViennaViennaAustria
| | - Farideh Alasti
- Division of Rheumatology, Department of Internal Medicine 3Medical University of ViennaViennaAustria
| | - Diane Lacaille
- Division of Rheumatology, Department of MedicineUniversity of British Columbia and Arthritis Research CanadaVancouverCanada
| | - Josef S. Smolen
- Division of Rheumatology, Department of Internal Medicine 3Medical University of ViennaViennaAustria
| | - David T. Felson
- Section of RheumatologyBoston University School of MedicineBostonMassachusetts
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20
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Studenic P, Aletaha D, de Wit M, Stamm TA, Alasti F, Lacaille D, Smolen JS, Felson DT. American College of Rheumatology/EULAR remission criteria for rheumatoid arthritis: 2022 revision. Ann Rheum Dis 2023; 82:74-80. [PMID: 36280238 PMCID: PMC9811102 DOI: 10.1136/ard-2022-223413] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In 2011, the American College of Rheumatology (ACR) and EULAR endorsed provisional criteria for remission in rheumatoid arthritis (RA), both Boolean-based and index-based. Based on recent studies indicating that a higher threshold for the patient global assessment (PtGA) may improve agreement between the two sets of criteria, our goals were to externally validate a revision of the Boolean remission criteria using a higher PtGA threshold and to validate the provisionally endorsed index-based criteria. METHODS We used data from four randomised trials comparing biological disease-modifying antirheumatic drugs to methotrexate or placebo. We tested the higher proposed PtGA threshold of 2 cm (Boolean2.0) (range 0-10 cm) compared with the original threshold of 1 cm (Boolean1.0). We analysed agreement between the Boolean-based and index-based criteria (Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI)) for remission and examined how well each remission definition predicted later good physical function (Health Assessment Questionnaire (HAQ) score≤0.5) and radiographic non-progression. RESULTS Data from 2048 trial participants, 1101 with early RA and 947 with established RA, were included. The proportion of patients with disease in remission at 6 months after treatment initiation increased when using Boolean2.0 compared with Boolean1.0, from 14.8% to 20.6% in early RA and 4.2% to 6.0% in established RA. Agreement between Boolean2.0 and the SDAI or CDAI remission criteria was better than for Boolean1.0, particularly in early disease. Boolean2.0, SDAI, and CDAI remission criteria had similar positive likelihood ratios (LRs) to predict radiographic nonprogression and a HAQ score of ≤0.5 (positive LR 3.8-4.3). The omission of PtGA (BooleanX) worsened the prediction of good functional outcomes. CONCLUSION Using the Boolean 2.0 criteria classifies, more patients as achieving remission and increases the agreement with index-based remission criteria without jeopardising predictive value for radiographic or functional outcomes. This revised Boolean definition and the previously provisionally endorsed index-based criteria were endorsed by ACR and EULAR.
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Affiliation(s)
- Paul Studenic
- Division of Rheumatology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden,Division of Rheumatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Maarten de Wit
- EULAR community of People with Arthritis/Rheumatism in Europe (PARE), Zürich, Switzerland
| | - Tanja A Stamm
- Division of Rheumatology, Department of Internal Medicine 3, Medical University of Vienna, Medical University of Vienna, Vienna, Austria
| | - Farideh Alasti
- Division of Rheumatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Diane Lacaille
- Division of Rheumatology, Department of Medicine, University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Josef S Smolen
- Division of Rheumatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - David T Felson
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
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21
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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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22
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Zhou YV, Lacaille D, Lu N, Kopec J, Qian Y, Nosyk B, Aviña-Zubieta JA, Esdaile J, Xie H. POS0521 RISKS OF SEVERE INFECTION AFTER THE INTRODUCTION OF bDMARDs IN NEWLY DIAGNOSED RHEUMATOID ARTHRITIS PATIENTS: A POPULATION-BASED INTERRUPTED TIME-SERIES ANALYSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1298] [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
BackgroundBiological disease-modifying anti-rheumatic drugs (bDMARDs) are effective in suppressing inflammation and preventing joint damage. But bDMARDs may be associated with increased risk of severe infection. Evidence on this is contradictory with some studies showing increased risk, whereas others reporting no significant changes.ObjectivesTo determine the impact of the introduction of bDMARDs on severe infection among patients newly diagnosed with RA compared with non-RA individuals.MethodsIn this age- and gender-matched cohort study using administrative health data for the population of BC, Canada, all incident RA patients diagnosed between 1995–2007 were identified. Non-RA individuals were randomly selected from the general control population to match with RA. Incident RA/non-RA individuals were then divided into quarterly cohorts according to their diagnosis date. Two outcomes were examined: (1) first severe infection (FSI) after RA onset necessitating hospitalization or occurring during hospitalization; and (2) all severe infections (ASI) after RA onset. We calculated the 8-year FSI and ASI rate for each cohort. We conducted interrupted time-series analyses to compare levels and trends of FSI and ASI in RA and non-RA individuals diagnosed during pre-bDMARDs (1995–2001) and post-bDMARDs (2003–2007) periods. Adjusted 8-year FSI and ASI rates for RA and non-RA cohorts diagnosed five years after bDMARDs introduction were compared with expected rates assuming no bDMARDs introduction, based on extrapolation of pre-bDMARDs trends.ResultsA total of 60,226 and 588,499 incident RA/non-RA individuals were identified. We identified 8,954 FSI and 14,245 ASI in RA, and 56,153 FSI and 79,819 ASI in non-RA. The 8-year FSI rates among RA patients diagnosed in the pre-bDMARDs period decreased over time but leveled off among those diagnosed in the post-period (Figure 1). The adjusted difference between the post- and pre-bDMARDs secular trends of 8-year FSI rates was 0.68 (p=0.03) in RA and 0.03 (p=0.67) in non-RA (Table 1). The 8-year ASI rates among RA patients diagnosed in the pre-bDMARDs period decreased over time but increased significantly among those diagnosed in the post-period (Figure 1). The adjusted difference between the post- and pre-bDMARDs secular trends of 8-year ASI rates was 1.85 (p=0.001) in RA and 0.12 (p=0.29) in non-RA (Table 1). For RA cohort diagnosed 5 years after bDMARDs introduction, ASI rate increased by 20.4% than expected rates assuming no bDMARDs introduction. In contrast, ASI rate in non-RA increased by only 10.9%.Table 1.Results of interrupted time-series analysis of FSI/ASI rates, adjusting for age, gender, chronic obstructive pulmonary disease, Romano Charlson Comorbidity Index, diabetes, chronic kidney diseases, alcoholism, cancer, prior hospitalization with infection and socio-economic status at disease diagnosis year, using stepwise model selectionOutcomeParameterRANon-RAUnadj. Diff (95% CI)Adj. Diff (95% CI)Unadj. Diff (95% CI)Adj. Diff (95% CI)p-valuep-valuep-valuep-valueFSITrend0.63 (0.03, 1.22) 0.04410.68 (0.09, 1.27) 0.02920.08 (-0.08, 0.25) 0.32370.03 (-0.12, 0.19) 0.6728Level (1 year post-intervention)0.50 (-2.00, 2.99) 0.69890.31 (-1.88, 2.49) 0.78470.41 (-0.21, 1.03) 0.20410.26 (-0.24, 0.75) 0.31035 years post-intervention3.01 (-0.85, 6.87) 0.13313.02 (-0.48, 6.52) 0.09860.75 (-0.24, 1.73) 0.14330.39 (-0.46, 1.25) 0.3721ASITrend1.84 (0.83, 2.84) 0.00091.85 (0.81, 2.89) 0.00110.28 (0.04, 0.53) 0.03050.12 (-0.10, 0.34) 0.2877Level (1 year post-intervention)-1.21 (-5.41, 3.00) 0.5763-1.44 (-5.44, 2.56) 0.48501.46 (0.42, 2.49) 0.00851.20 (0.38, 2.02) 0.00645 years post-intervention6.14 (0.26, 12.01) 0.04665.97 (0.02, 11.93) 0.05602.60 (1.08, 4.12) 0.00171.69 (0.45, 2.92) 0.0109Figure 1.Unadjusted rates.ConclusionArthritis onset after bDMARDs introduction is associated with an elevated risk of severe infection in RA patients, compared with matched non-RA individuals.AcknowledgementsWe would like to thank the Ministry of Health of British Columbia and Population Data BC for providing access to the administrative data. All inferences, opinions, and conclusions drawn in this publication are those of the authors, and do not reflect the opinions or policies of the Data Stewards or the [British Columbia] Ministry of Health. No personal identifying information was made available as part of this study. Procedures used were in compliance with British Columbia’s Freedom in Information and Privacy Protection Act. Ethics approval was obtained from the University of British Columbia’s Behavioral Research Ethics Board (H15-00887).Disclosure of InterestsNone declared.
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Zhou YV, Lacaille D, Lu N, Kopec J, Qian Y, Nosyk B, Aviña-Zubieta JA, Esdaile J, Xie H. POS0503 RISKS OF CARDIOVASCULAR EVENTS AFTER THE INTRODUCTION OF bDMARDs IN NEWLY DIAGNOSED RHEUMATOID ARTHRITIS PATIENTS: A POPULATION-BASED INTERRUPTED TIME-SERIES ANALYSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.351] [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
BackgroundRheumatoid arthritis (RA) is associated with increased risk of cardiovascular (CV) events. Biological disease-modifying anti-rheumatic drugs (bDMARDs) are effective in suppressing inflammation and preventing joint damage and may help lower the risk of CV events. However, recent epidemiological studies have shown mixed results with some suggesting a lower risk of CV events, while others reporting no significant differences.ObjectivesTo determine the impact of the introduction of bDMARDs on incident cardiovascular disease (CVD) among patients newly diagnosed with RA compared with matched non-RA individuals.MethodsIn this age- and gender-matched cohort study using administrative health data for the population of BC, Canada, all incident RA patients diagnosed between 1995–2007 were identified. Non-RA individuals were randomly selected from the general control population to match with RA. Incident RA and non-RA individuals were then divided into quarterly cohorts according to their diagnosis date. The outcome of interest was incident CVD event after RA onset, which include acute myocardial infarction, cerebrovascular accident, and venous thromboembolism. We calculated the 8-year incident CVD rate for each cohort. We conducted interrupted time-series analyses to compare levels and trends of CVD in RA and non-RA individuals diagnosed during pre-bDMARDs (1995–2001) and post-bDMARDs (2003–2007) periods with intervention time set at year of 2002. Adjusted 8-year CVD rates for RA and non-RA cohorts diagnosed five years after bDMARDs introduction were compared with expected rates assuming no bDMARDs introduction, based on extrapolation of pre-bDMARDs trends.ResultsA total of 60,226 and 588,499 incident RA and non-RA individuals were identified. We identified 6,740 and 48,653 incident CVD events in total in RA and non-RA individuals, respectively. We observe no change in the secular trends of the 8-year CVD rates in both RA and non-RA individuals diagnosed in pre- and post-bDMARDS periods (Figure 1): the adjusted difference between the post- and pre-bDMARDs secular trends of 8-year CVD rates was 0.23 (p=0.26) for RA patients and -0.07 (p=0.33) for non-RA individuals (Table 1). However, we observed a reduction in the level of CVD rates among RA patients diagnosed in the post-bDMARDs period and no change in non-RA (Figure 1): the adjusted difference in level comparing points immediately before and after the intervention, and accounting for pre-intervention trend was -1.61 (p=0.03) in RA, while it was -0.02 (p=0.93) in non-RA (Table 1).Table 1.Results of interrupted time-series analysis of incident CVD rates, adjusting for age, gender, chronic obstructive pulmonary disease, Romano Charlson Comorbidity Index, diabetes, angina, hypertension, chronic kidney disease, peripheral vascular disease, atrial fibrillation, glucocorticoid, non-steroidal anti-inflammatory drugs, CVD medications, fibrates, contraceptives, and aspirin use at disease diagnosis year, using stepwise model selectionOutcomeParameterRANon-RAUnadj. Diff (95% CI)Adj. Diff (95% CI)Unadj. Diff (95% CI)Adj. Diff (95% CI)p-valuep-valuep-valuep-valueCVDTrend-0.15 (-0.72, 0.42) 0.60860.23 (-0.17, 0.64) 0.2620-0.09 (-0.27, 0.08) 0.3084-0.07 (-0.20, 0.07) 0.3290Level (1 year post-intervention)-1.36 (-3.17, 0.45) 0.1474-1.61 (-2.96, -0.25) 0.02510.22 (-0.41, 0.84) 0.5011-0.02 (-0.44, 0.40) 0.93455 years post-intervention-1.96 (-4.48, 0.55) 0.1332-0.67 (-2.80, 1.46) 0.5418-0.15 (-1.06, 0.75) 0.7421-0.29 (-0.97, 0.39) 0.4102Figure 1.Unadjusted rates.ConclusionArthritis onset after bDMARDs introduction is associated with a significant reduction in the risk of incident CVD events among RA patients, but not in the matched non-RA individuals.AcknowledgementsWe would like to thank the Ministry of Health of British Columbia and Population Data BC for providing access to the administrative data. All inferences, opinions, and conclusions drawn in this publication are those of the authors, and do not reflect the opinions or policies of the Data Stewards or the [British Columbia] Ministry of Health. No personal identifying information was made available as part of this study. Procedures used were in compliance with British Columbia’s Freedom in Information and Privacy Protection Act. Ethics approval was obtained from the University of British Columbia’s Behavioral Research Ethics Board (H15-00887).Disclosure of InterestsNone declared.
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Verstappen S, Boonen A, Wilkinson S, Beaton D, Bosworth A, Canas da Silva J, Crepaldi G, Dadoun S, Hofstetter C, Mihai C, Ramiro S, Sakellariou G, Meisalu S, Wallman JK, Lacaille D. POS0011 COMPARISON OF PSYCHOMETRIC PROPERTIES OF FOUR GLOBAL MEASURES OF PRESENTEEISM IN PATIENTS WITH OSTEOARTHRITIS AND INFLAMMATORY ARTHRITIS: A EULAR-PRO STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4310] [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
BackgroundWork is an important outcome for people with inflammatory arthritis (IA including PsA, RA, AxSpA) and osteoarthritis (OA). It is known that people with IA and OA are at increased risk of sick leave and have to stop working early due to ill health. In addition to being at increased risk of becoming work disabled and increased absenteeism, high levels of presenteeism (i.e. reduced productivity/limited ability to work due to ill health whilst at work) have also been reported. Several instruments exist to measure presenteeism, including single-item global measures and multi-item instruments. In some studies using single-item global instruments may be more feasible. However, available global instruments differ in concept, recall period and reference. It is important to understand which of the measures have good psychometric properties before using them in clinical studies.ObjectivesTo assess the psychometric properties of four global presenteeism instruments.MethodsPatients with IA or OA were recruited via rheumatology outpatient clinics to a large international, longitudinal observational study including 8 European countries and Canada. Participants completed a survey at baseline, 1, 2, 3, 4 wks, 2 months and 3 months. The four global measures of presenteeism included: Work Productivity and Activity Impairment Questionnaire (WPAI), Work Productivity Scale–Rheumatoid Arthritis (WPS-RA), Work Ability Index (WAI) and the Quality*Quantity questionnaire (QQtotal/10) scale. To facilitate score interpretation the WAI and QQtotal were reversed. Pain was measured using an 11-point Likert scale. Spearman correlations were calculated between the presenteeism measures and the Workplace Activity Limitations Scale (WALS), a validated multi-item measure of presenteeism, and HAQ to evaluate construct validity (validity: r <0.50=low; r >0.50-<0.70=moderate; r >0.70=high). Test-retest reliability of the 4 presenteeism scales (baseline-1wk) was measured applying ICC in patients with stable disease (i.e. same pain score at baseline and 1wk) (reliability: ICC<0.40=poor; ICC 0.40-0.75=fair to good; ICC >0.75=excellent). Responsiveness during 3 months was measured comparing patients with improvement in pain score (>1 point improvement in pain score (~MCID pain)) with patients with no change or worsening in pain score. The two groups were compared applying Mann Whitney U test.ResultsThis international study included 550 patients with a mean age of 47.8 (SD 9.9) yrs and 61.4% were female. Mean (SD) disease duration since diagnosis was 10.8 (10.4) yrs and 91.2% had IA. Mean (SD) presenteeism scores at baseline were: WPAI=2.9 (2.7); WPS-RA=3.4 (2.7); WAI=2.7 (2.4); and QQtotal=3.1 (3.2). The correlations between the global measures and with WALS and HAQ were moderate to good, except for QQtotal and HAQ which was low (Table 1). In patients with the same stable pain scores at baseline-1wk (n=141) ICC scores were good to excellent, respectively: WPAI (0.771), WPS-RA (0.752), WAI (0.663), and QQtotal (0.650). An improvement in pain during the 3 month study duration was observed in 145/381 (38%) of the patients. In these patients a significant reduction in mean (SD) change presenteeism was observed for all four presenteeism scales compared to those with no change or worsening of the pain score: WPAI (-1.0 (2.37) vs 0.68 (2.40), p<0.01); WPS-RA (-0.76 (2.57) vs 0.43 (2.10), p<0.001); WAI (-0.09 (2.34) vs 0.41 (2.46), p<0.001); QQtotal (-0.57 (3.16) vs 0.79 (3.1), p<0.01).Table 1.WPAIWPS-RAWAIQQtotalWALSHAQWPAI-0.81640.59920.51840.62690.5592WPS-RA-0.58360.52170.60550.5669WAI-0.58660.52310.5168QQtotal-0.50250.4367ConclusionThe psychometric properties of all 4 global presenteeism scales were moderate to good, with slightly better scores for both the WPS-RA and WPAI instruments both measuring the impact of OA and IA on productivity.Disclosure of InterestsSuzanne Verstappen Consultant of: EUOSHA, Grant/research support from: AbbVie, BMS. EULAR, Annelies Boonen Speakers bureau: Abbvie / Galapagos, Consultant of: Galapagos, Sarah Wilkinson: None declared, Dorcas Beaton: None declared, Ailsa Bosworth: None declared, José Canas da Silva: None declared, Gloria Crepaldi: None declared, Sabrina Dadoun: None declared, Cathie Hofstetter: None declared, Carina Mihai Speakers bureau: Boehringer-Ingelheim, Mepha, MED Talks Switzerland, Consultant of: Boehringer-Ingelheim, Janssen, Grant/research support from: Roche, Boehringer-Ingelheim, Sofia Ramiro Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: Grant: AbbVie, Galapagos, Novartis, Pfizer, UCB, Garifallia Sakellariou Consultant of: Abbvie, BMS and Galapagos., Grant/research support from: Abbvie, BMS and Galapagos., Sandra Meisalu: None declared, Johan K Wallman Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Grant/research support from: AbbVie, Amgen, Eli Lilly, Novartis, Pfizer., Diane Lacaille: None declared
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Marozoff S, Fazal ZA, Tan J, Lu N, Hoens A, Lacaille D, Kopec J, Xie H, Loree JM, Esdaile J, Aviña-Zubieta JA. OP0248 SEVERE COVID-19 OUTCOMES AMONG PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES: A POPULATION-BASED STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1107] [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 rheumatic diseases (ARDs) may be at greater risk of severe COVID-19 outcomes than individuals in the general population.ObjectivesThis study assesses the risk of COVID-19-related hospitalization, intensive care unit (ICU) admission, and COVID-19-specific mortality in patients with ARDs compared to matched general population comparators.MethodsWe conducted a population-based cohort study, using administrative datasets from British Columbia, Canada (February 2020-August 2021). Among all test-positive SARS-CoV-2 adults, we used ICD codes to identify all individuals with an ARD: rheumatoid arthritis (RA), psoriasis/psoriatic arthritis (PsO/PsA), ankylosing spondylitis (AS), and systemic autoimmune rheumatic diseases (SARDs), including systemic lupus erythematosus (SLE), Sjogren’s syndrome, systemic sclerosis, myositis, and adult systemic vasculitides. Individuals with an ARD were matched 1:5 to general population test-positive SARS-CoV-2 individuals on age (± 5 years), sex, month/year of initial positive SARS-CoV-2 test, and health authority. Conditional logistic regression models adjusting for socioeconomic status, Charlson comorbidity index, hypertension, rural address, and number of previous COVID-19 PCR tests were performed to assess risk of COVID-19-related hospitalizations, ICU admissions, and COVID-19-specific mortality (mortality with primary ICD code for COVID-19).ResultsThe risk of COVID-19-related hospitalization was significantly increased for patients with ARDs overall (aOR: 1.30) (Table 1). Within ARDs, the patient group at greatest risk of hospitalization was adult systemic vasculitides (aOR: 2.18). The risk of ICU admission was significantly increased for patients with ARDs overall (aOR: 1.30). Within ARDs, the patient group at greatest risk of ICU admission was those with AS (aOR: 2.03). The risk of COVID-19-specific mortality was significantly increased for patients with ARDs overall (aOR: 1.24). Within ARDs, the patient group at greatest risk of COVID-19-specific mortality was those with AS (aOR: 2.15).Table 1.Risk of severe COVID-19 outcomes among patients with ARDsHospitalizationsICU admissionsCOVID-19-specific mortalityn (%)aOR (95% CI)n (%)aOR (95% CI)n (%)aOR (95% CI)ARDs (6,279)780 (12.4)1.30 (1.19, 1.43)225 (3.6)1.30 (1.11, 1.51)229 (3.7)1.24 (1.05, 1.47)ARD comparators (31,130)2,843 (9.1)1.00807 (2.6)1.00847 (2.7)1.00RA(2,067)321 (15.5)1.34 (1.15, 1.54)95 (4.6)1.30 (1.03, 1.65)103 (5.0)1.18 (0.92, 1.52)RA comparators (10,197)1,151 (11.3)1.00336 (3.3)1.00400 (3.9)1.00PsO/PsA(2,695)263 (9.8)1.17 (1.01, 1.37)65 (2.4)0.90 (0.68, 1.19)68 (2.5)0.93 (0.68, 1.26)PsO/PsA comparators (13,411)1,052 (7.8)1.00332 (2.5)1.00309 (2.3)1.00AS(529)51 (9.6)1.36 (0.95, 1.94)20 (3.8)2.03 (1.18, 3.50)13 (2.5)2.15 (1.02, 4.55)AS comparators (2,631)180 (6.8)1.0048 (1.8)1.0032 (1.2)1.00SARDs(1,118)168 (15.0)1.62 (1.32, 2.00)52 (4.7)1.74 (1.24, 2.44)49 (4.4)1.44 (1.00, 2.10)SARDs comparators (5,532)490 (8.9)1.00135 (2.4)1.00157 (2.8)1.00SLE(239)37 (15.5)1.88 (1.18, 3.00)11 (4.6)1.67 (0.75, 3.74)<50.85 (0.17, 4.29)SLE comparators (1,187)77 (6.5)1.0026 (2.2)1.0013 (1.1)1.00Sjogren’s(96)15 (15.6)2.07 (0.94, 4.58)<5*<5*Sjogren’s comparators (477)35 (7.4)1.0014 (2.9)1.0015 (3.2)1.00Myositis(30)5 (16.7)3.18 (0.69, 14.55)<5*<5*Myositis comparators (150)12 (8.0)1.00<51.007 (4.7)1.00Vasculitides(82)25 (30.5)2.18 (1.17, 4.05)8 (9.8)1.70 (0.70, 4.16)<5*Vasculitides comparators (404)64 (15.8)1.0021 (5.2)1.0016 (4.0)1.00Results for systemic sclerosis not presented; sample size too small.*Unable to be calculated (small sample size)ConclusionThe risk of severe COVID-19 outcomes is increased in some ARDs, although magnitude differs across individual diseases. Strategies to mitigate risk, such as booster vaccination, prompt diagnosis, and early intervention with available therapies (e.g., oral antivirals) should be prioritized in these groups according to risk.AcknowledgementsThis work was supported by the Michael Smith Foundation for Health Research (grant COV-2020-1075) and the BC SUPPORT Unit (grant C19-PE-V3).Disclosure of InterestsNone declared
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Widdifield J, Kwong JC, Chen S, Eder L, Benchimol EI, Kaplan GG, Hitchon C, Aviña-Zubieta JA, Lacaille D, Chung H, Bernatsky S. Vaccine effectiveness against SARS-CoV-2 infection and severe outcomes among individuals with immune-mediated inflammatory diseases tested between March 1 and Nov 22, 2021, in Ontario, Canada: a population-based analysis. The Lancet Rheumatology 2022; 4:e430-e440. [PMID: 35441151 PMCID: PMC9009845 DOI: 10.1016/s2665-9913(22)00096-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background We estimated COVID-19 vaccine effectiveness against SARS-CoV-2 infection and severe COVID-19 outcomes among individuals with immune-mediated inflammatory diseases in Ontario, Canada. Methods In this population-based analysis, we used a test-negative design across four immune-mediated inflammatory disease population-based cohorts, comprising individuals with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and inflammatory bowel disease. We identified all SARS-CoV-2 tests done in these populations between March 1 and Nov 22, 2021 (a period in which there was rapid uptake of vaccines, and the alpha [B.1.1.7] and delta [B.1.617.2] SARS-CoV-2 variants were predominantly circulating in Canada) and separately assessed outcomes of SARS-CoV-2 infection and severe COVID-19 outcomes (hospitalisation due to COVID-19 and death due to COVID-19) for each disease group. We used multivariable logistic regression to estimate the effectiveness of one, two, and three doses of mRNA-based COVID-19 vaccine (BNT162b2 [Pfizer–BioNTech], or mRNA-1273 [Moderna]) among individuals at the time of SARS-CoV-2 testing. Findings Between March 1 and Nov 22, 2021, we identified 2127 (5·9%) test-positive cases among 36 145 individuals (26 476 [73·2%] were female and 9669 [26·8%] were male) with rheumatoid arthritis tested, 476 (6·1%) test-positive cases among 7863 individuals (4130 [52·5%] were female and 3733 [47·5%] were male) with ankylosing spondylitis tested, 3089 (6·5%) test-positive cases among 47 199 individuals (26 062 [55·2%] were female and 21 137 [44·8%] were male) with psoriasis tested, and 1702 (5·4%) test-positive cases among 31 311 individuals (17 716 [56·6%] were female and 13 595 [43·4%] were male) with inflammatory bowel disease tested. Adjusted vaccine effectiveness of two doses against infection was 83% (95% CI 80–86) in those with rheumatoid arthritis, 89% (83–93) among those with ankylosing spondylitis, 84% (81–86) among those with psoriasis, and 79% (74–82) among those with inflammatory bowel disease. After two vaccine doses, effectiveness against infection generally peaked 31–60 days after vaccination and waned gradually with each additional month. Vaccine effectiveness against severe outcomes after two doses was 92% (95% CI 88–95) in those with rheumatoid arthritis, 97% (83–99) among those with ankylosing spondylitis, 92% (86–95) among those with psoriasis, and 94% (88–97) among those with inflammatory bowel disease. Vaccine effectiveness after a third dose against infection was similar to or higher than after the second dose (ranging from 76% [47–89] to 96% [72–99]), although due to a paucity of events, estimates could not be calculated for some subgroups for severe outcomes. Interpretation Two vaccine doses were found to be highly effective against both SARS-CoV-2 infection and severe COVID-19 outcomes in patients with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and inflammatory bowel disease during the study period. Research is needed to determine the durability of effectiveness of three doses over time, particularly against emerging variants. Funding Public Health Agency of Canada
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Affiliation(s)
- Jessica Widdifield
- Holland Bone & Joint Program, Sunnybrook Research Institute, Toronto ON, Canada
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, Canada
| | | | - Lihi Eder
- Division of Rheumatology, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Eric I Benchimol
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - Gilaad G Kaplan
- Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Carol Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - J Antonio Aviña-Zubieta
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Diane Lacaille
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | | | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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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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Felson DT, Lacaille D, LaValley MP, Aletaha D. Reply. Arthritis Care Res (Hoboken) 2022; 74:502-503. [PMID: 34931490 DOI: 10.1002/acr.24842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/06/2022]
Affiliation(s)
- David T Felson
- Boston University School of Medicine Boston, Massachusetts and University of Manchester and the NIHR Manchester BRC, Manchester University NHS Trust, Manchester, UK
| | - Diane Lacaille
- University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, 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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Felson D, Lacaille D, LaValley MP, Aletaha D. Response to: Correspondence on 'Re-examining remission definitions in rheumatoid arthritis: considering the 28-Joint Disease Activity Score, C-reactive protein level and patient global assessment' by Felson et al. Ann Rheum Dis 2022:annrheumdis-2021-221941. [PMID: 35177411 DOI: 10.1136/annrheumdis-2021-221941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/26/2022] [Indexed: 11/03/2022]
Affiliation(s)
- David Felson
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Diane Lacaille
- Department of Medicine, Arthritis Research Canada, Richmond, British Columbia, Canada.,Medicine, Division of Rheumatology, University of British Columbia, Richmond, British Columbia, Canada
| | | | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
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Felson D, LaValley M, Lacaille D, Aletaha D. Reply. ACR Open Rheumatol 2022; 4:269-270. [PMID: 35089654 PMCID: PMC8916574 DOI: 10.1002/acr2.11401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | - Diane Lacaille
- The University of British Columbia and Arthritis Research Canada, Vancouver, BC, Canada
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Widdifield J, Eder L, Chen S, Kwong JC, Hitchon C, Lacaille D, Aviña-Zubieta JA, Svenson LW, Bernatsky S. COVID-19 Vaccination Uptake among individuals with Immune-Mediated Inflammatory Diseases in Ontario, Canada between December 2020 and October 2021: A population-based analysis. J Rheumatol 2022; 49:531-536. [PMID: 35034001 DOI: 10.3899/jrheum.211148] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/04/2022]
Abstract
OBJECTIVE We assessed COVID-19 vaccine uptake among individuals with immune-mediated inflammatory diseases (IMID) and the Ontario general population. METHODS We studied all residents 16 years and older who were alive and enrolled in Ontario's universal health insurance plan as of December 14, 2020 when vaccination commenced (n=12,435,914). Individuals with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), psoriasis (PsO), and inflammatory bowel disease (IBD) were identified using established disease-specific case definitions applied to health administrative data. Vaccination status was extracted from the provincial COVaxON registry. Weekly cumulative proportions of first and second doses up until October 3, 2021 were expressed as the vaccinated percentage of each disease group, and compared to the general Ontario population, and stratified by age. RESULTS By October 3, 2021, the cumulative percentage with at least one dose was 82.1% for the general population, 88.9% for RA, 87.4% for AS, 90.6% for PsA, 87.3% for PsO, and 87.0% for IBD. There was also a higher total cumulative percentage with two doses among IMIDs (83.8-88.2%) vs the general population (78.0%). The difference was also evident when stratifying by age. Individuals with IMIDs in the youngest age group initially had earlier uptake than the general population but remain the lowest age group with two doses (70.6% in the general population vs. 73.7-79.2% across IMID groups). CONCLUSION While implementation of COVID-19 vaccination programs has differed globally, these Canadian estimates are the first to reassuringly show higher COVID-19 vaccine uptake among individuals with IMIDs.
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Affiliation(s)
- Jessica Widdifield
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Lihi Eder
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Simon Chen
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Jeffrey C Kwong
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Carol Hitchon
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Diane Lacaille
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - J Antonio Aviña-Zubieta
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Lawrence W Svenson
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
| | - Sasha Bernatsky
- Institute of Health Policy, Management & Evaluation, University of Toronto, Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto; University of Toronto, and Women's College Research Institute, Women's College Hospital ICES; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; Public Health Ontario, Toronto, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Canada; Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada, Division of Preventive Medicine, University of Alberta, Edmonton, Canada, School of Public Health, University of Alberta, Edmonton, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec. Corresponding Author: Jessica Widdifield Sunnybrook Research Institute, MG 352 - 2075 Bayview Ave, Toronto ON, M4N 3M5 E-mail:
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Felson DT, Lacaille D, LaValley MP, Aletaha D. Reexamining Remission Definitions in Rheumatoid Arthritis: Considering the Twenty-Eight-Joint Disease Activity Score, C-Reactive Protein Level, and Patient Global Assessment. Arthritis Rheumatol 2022; 74:5-9. [PMID: 34783188 PMCID: PMC10530631 DOI: 10.1002/art.41959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/24/2021] [Indexed: 01/17/2023]
Affiliation(s)
- David T. Felson
- David T. Felson, MD, MPH: Boston University School of Medicine, Boston, Massachusetts, and University of Manchester and the NIHR Manchester Biomedical Research Center, Manchester University NHS Trust, Manchester, UK
| | - Diane Lacaille
- Diane Lacaille, MD, MHSc: University of British Columbia and Arthritis Research Canada, Vancouver, British Colombia, Canada
| | - Michael P. LaValley
- Michael P. LaValley, PhD: Boston University School of Public Health, Boston, Massachusetts
| | - Daniel Aletaha
- Daniel Aletaha, MD, MS, MBA: Medical University of Vienna, Vienna, Austria
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Felson DT, Lacaille D, LaValley MP, Aletaha D. Reexamining Remission Definitions in Rheumatoid Arthritis: Considering the Twenty-Eight-Joint Disease Activity Score, C-Reactive Protein Level, and Patient Global Assessment. Arthritis Care Res (Hoboken) 2022; 74:1-5. [PMID: 34783179 DOI: 10.1002/acr.24772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022]
Affiliation(s)
- David T Felson
- Boston University School of Medicine, Boston, Massachusetts, and University of Manchester and the NIHR Manchester Biomedical Research Center, Manchester University NHS Trust, Manchester, UK
| | - Diane Lacaille
- University of British Columbia and Arthritis Research Canada, Vancouver, British Colombia, Canada
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Felson D, Lacaille D, LaValley MP, Aletaha D. Re-examining remission definitions in rheumatoid arthritis: considering the 28-Joint Disease Activity Score, C-reactive protein level and patient global assessment. Ann Rheum Dis 2022; 81:4-7. [PMID: 34785493 DOI: 10.1136/annrheumdis-2021-221653] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 11/03/2022]
Affiliation(s)
- David Felson
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
- the University of Manchester, Manchester, UK
| | - Diane Lacaille
- Arthritis Research Canada, Richmond, British Columbia, Canada
- Medicine, Division of Rheumatology, University of British Columbia, Richmond, British Columbia, Canada
| | | | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
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Ruel-Gagné S, Simonyan D, Légaré J, Bessette L, Fortin PR, Lacaille D, Dogba MJ, Michou L. Expectations and educational needs of rheumatologists, rheumatology fellows and patients in the field of precision medicine in Canada, a quantitative cross-sectional and descriptive study. BMC Rheumatol 2021; 5:52. [PMID: 34839831 PMCID: PMC8627786 DOI: 10.1186/s41927-021-00222-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Precision medicine, as a personalized medicine approach based on biomarkers, is a booming field. In general, physicians and patients have a positive attitude toward precision medicine, but their knowledge and experience are limited. In this study, we aimed at assessing the expectations and educational needs for precision medicine among rheumatologists, rheumatology fellows and patients with rheumatic diseases in Canada. Methods We conducted two anonymous online surveys between June and August 2018, one with rheumatologists and fellows and one with patients assessing precision medicine expectations and educational needs. Descriptive statistics were performed. Results 45 rheumatologists, 6 fellows and 277 patients answered the survey. 78% of rheumatologists and fellows and 97.1% of patients would like to receive training on precision medicine. Most rheumatologists and fellows agreed that precision medicine tests are relevant to medical practice (73.5%) with benefits such as helping to determine prognosis (58.9%), diagnosis (79.4%) and avoid treatment toxicity (61.8%). They are less convinced of their usefulness in helping to choose the most effective treatment and to improve patient adherence (23.5%). Most patients were eager to take precision medicine tests that could predict disease prognosis (92.4%), treatment response (98.1%) or drug toxicity (93.4%), but they feared potential negative impacts like loss of insurability (62.2%) and high cost of the test (57.5%). Conclusions Our study showed that rheumatologists and patients in Canada are overall interested in getting additional precision medicine education. Indeed, while convinced of the potential benefits of precision medicine tests, most physicians don’t feel confident in their abilities and consider their training insufficient to incorporate them into clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00222-2.
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Affiliation(s)
- Sophie Ruel-Gagné
- Division of Rheumatology-R4774, Department of Medicine, CHU de Québec-Université Laval, 2705 Boulevard Laurier, Quebec, QC, G1V 4G2, Canada
| | - David Simonyan
- Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada
| | | | - Louis Bessette
- Division of Rheumatology-R4774, Department of Medicine, CHU de Québec-Université Laval, 2705 Boulevard Laurier, Quebec, QC, G1V 4G2, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada
| | - Paul R Fortin
- Division of Rheumatology-R4774, Department of Medicine, CHU de Québec-Université Laval, 2705 Boulevard Laurier, Quebec, QC, G1V 4G2, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada
| | - Diane Lacaille
- Arthritis Research Canada, University of British Columbia, Vancouver, BC, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada.,Centre de Recherche en Santé Durable VITAM, Quebec, Canada
| | - Laëtitia Michou
- Division of Rheumatology-R4774, Department of Medicine, CHU de Québec-Université Laval, 2705 Boulevard Laurier, Quebec, QC, G1V 4G2, Canada. .,Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada.
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Avina-Galindo AM, Fazal ZA, Marozoff S, Kwan J, Lu N, Hoens AM, Kopec J, Lacaille D, Xie H, Loree JM, Avina-Zubieta JA. Immunosuppression and COVID-19 infection in British Columbia: Protocol for a linkage study of population-based administrative and self-reported survey data. PLoS One 2021; 16:e0259601. [PMID: 34797824 PMCID: PMC8604283 DOI: 10.1371/journal.pone.0259601] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Cases of the novel coronavirus disease (COVID-19) continue to spread around the world even one year after the declaration of a global pandemic. Those with weakened immune systems, due to immunosuppressive medications or disease, may be at higher risk of COVID-19. This includes individuals with autoimmune diseases, cancer, transplants, and dialysis patients. Assessing the risk and outcomes of COVID-19 in this population has been challenging. While administrative databases provide data with minimal selection and recall bias, clinical and behavioral data is lacking. To address this, we are collecting self-reported survey data from a randomly selected subsample with and without COVID-19, which will be linked to administrative health data, to better quantify the risk of COVID-19 infection associated with immunosuppression. Methods and analysis Using administrative and laboratory data from British Columbia (BC), Canada, we established a population-based case-control study of all individuals who tested positive for SARS-CoV-2. Each case was matched to 40 randomly selected individuals from two control groups: individuals who tested negative for SARS-CoV-2 (i.e., negative controls) and untested individuals from the general population (i.e., untested controls). We will contact 1000 individuals from each group to complete a survey co-designed with patient partners. A conditional logistic regression model will adjust for potential confounders and effect modifiers. We will examine the odds of COVID-19 infection according to immunosuppressive medication or disease type. To adjust for relevant confounders and effect modifiers not available in administrative data, the survey will include questions on behavioural variables that influence probability of being tested, acquiring COVID-19, and experiencing severe outcomes. Ethics and dissemination This study has received approval from the University of British Columbia Clinical Research Ethics Board [H20-01914]. Findings will be disseminated through scientific conferences, open access peer-reviewed journals, COVID-19 research repositories and dissemination channels used by our patient partners.
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Affiliation(s)
| | - Zahra A. Fazal
- Arthritis Research Canada, Vancouver, Canada
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jessie Kwan
- Arthritis Research Canada, Vancouver, Canada
- Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Na Lu
- Arthritis Research Canada, Vancouver, Canada
| | - Alison M. Hoens
- Arthritis Research Canada, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacek Kopec
- Arthritis Research Canada, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, Canada
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jonathan M. Loree
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | - J. Antonio Avina-Zubieta
- Arthritis Research Canada, Vancouver, Canada
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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Felson DT, Lacaille D, LaValley MP, Aletaha D. Reexamining Remission Definitions in Rheumatoid Arthritis: Considering the Twenty-Eight-Joint Disease Activity Score, C-Reactive Protein Level, and Patient Global Assessment. ACR Open Rheumatol 2021; 4:123-127. [PMID: 34783200 PMCID: PMC8843760 DOI: 10.1002/acr2.11345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- David T Felson
- Boston University School of Medicine, Boston, Massachusetts, and University of Manchester and the NIHR Manchester Biomedical Research Center, Manchester University NHS Trust, Manchester, UK
| | - Diane Lacaille
- University of British Columbia and Arthritis Research Canada, Vancouver, British Colombia, Canada
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Felson D, Lacaille D, LaValley MP, Aletaha D. Reexamining remission definitions in rheumatoid arthritis: considering the twenty-eight-joint Disease Activity Score, C-reactive protein level and patient global assessment. RMD Open 2021; 7:e002034. [PMID: 34785578 PMCID: PMC8587341 DOI: 10.1136/rmdopen-2021-002034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- David Felson
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Diane Lacaille
- Arthritis Research Canada, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Daniel Aletaha
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
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Zhou VY, Lacaille D, Lu N, Kopec J, Garbuz D, Qian Y, Aviña-Zubieta JA, Esdaile J, Xie H. Has the incidence of total joint arthroplasty in rheumatoid arthritis decreased in the era of biologics use? A population-based cohort study. Rheumatology (Oxford) 2021; 61:1819-1830. [PMID: 34373899 DOI: 10.1093/rheumatology/keab643] [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: 05/07/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine whether the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) was associated with reduced incidences of total hip and knee arthroplasty (THA/TKA) among patients with rheumatoid arthritis (RA) compared with osteoarthritis (OA). METHODS Using a population-based cohort in British Columbia, Canada, RA and OA patients diagnosed between 1995-2007 were divided into semi-annual cohorts according to diagnosis date. For each cohort, we calculated 8-year incidence rates of THA and TKA. We compared levels and trends of THA/TKA incidence in RA/OA patients diagnosed during pre-bDMARDs (1995-2001) and post-bDMARDs (2003-2007) periods using interrupted time-series analysis, adjusting for baseline characteristics. Adjusted 8-year TJA incidence estimated for RA/OA cohorts diagnosed five years after bDMARDs introduction were compared with expected rates assuming no bDMARDs introduction, based on extrapolation of pre-bDMARDs trends. RESULTS We identified 60,227 RA and 288,260 OA incident cases. For cohorts diagnosed pre-bDMARDs, 8-year THA/TKA incidence rates increased over time in both RA and OA. For cohorts diagnosed post-bDMARDs, these rates decreased over time in RA but continued to increase for OA. For RA, differences between the post- and pre-bDMARDs secular trends in incidence rates were -0.49 (p = 0.002) for THA and -0.36 (p = 0.003) for TKA, compared to + 0.40 (p = 0.006) and +0.54 (p < 0.001), respectively, for OA. For RA cohorts diagnosed five years after bDMARDs introduction, 8-year incidence were 26.9% and 12.6% lower for THA and TKA, respectively, than expected rates. In contrast, corresponding rates in OA were higher by 11.7% and 16.6%, respectively. CONCLUSION Arthritis onset after bDMARDs introduction is associated with a significant reduction in THA/TKA incidence in RA, but not in OA. The reduction reflects a significant improvement in RA treatment during the biological era.
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Affiliation(s)
- Vivienne Y Zhou
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Na Lu
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Jacek Kopec
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Division of Epidemiology, Biostatistics and Public Health Practice, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Don Garbuz
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Yi Qian
- Sauder School of Business, University of British Columbia, Vancouver, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - John Esdaile
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
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Bohm V, Lacaille D, Spencer N, Barber CE. Scoping review of balanced scorecards for use in healthcare settings: development and implementation. BMJ Open Qual 2021; 10:bmjoq-2020-001293. [PMID: 34244173 PMCID: PMC8273481 DOI: 10.1136/bmjoq-2020-001293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/28/2020] [Accepted: 06/28/2021] [Indexed: 11/04/2022] Open
Abstract
Objective Balanced scorecards (BSCs) were developed in the early 1990s in corporate settings as a strategic performance management tool that emphasised measurement from multiple perspectives. Since their introduction, BSCs have been adapted for a variety of industries, including to healthcare settings. The aim of this scoping review was to describe the application of BSCs in healthcare. Methods Medline, Embase and CINHAL databases were searched using keywords and medical subject headings for ‘balanced scorecard’ and related terms from 1992 to 17/04/2020. Title and abstract screening and full text review were conducted in duplicate by two reviewers. Studies describing the development and/or implementation of a BSC in a healthcare setting were included. Data were abstracted using pilot-tested forms and reviewed for key themes and findings. Results 8129 records were identified and 841 underwent a full text review. 87 articles were included. Over 26 countries were represented and the majority of BSCs were applied at a local level (54%) in hospital settings (41%). While almost all discussed Kaplan and Norton’s original BSC (97%), only 69% described alignment with a strategic plan. Patients/family members were rarely involved in development teams (3%) which typically were comprised of senior healthcare leaders/administrators. Only 21% of BSCs included perspectives using identical formatting to the original BSC description. Lessons learnt during development addressed three main themes: scorecard design, stakeholder engagement and feasibility. Conclusions BSC frameworks have been used in various healthcare settings but frequently undergo adaptation from the original description in order to suit a specific healthcare context. Future BSCs should aim to include patients/families to promote patient-centred healthcare systems. Considering the heterogeneity evident in development approaches, methodological guidance in this area is warranted.
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Affiliation(s)
- Victoria Bohm
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Richmond, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Spencer
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claire Eh Barber
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada .,Arthritis Research Canada, Richmond, British Columbia, Canada
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Sheriff I, Lima A, Tseng O, Aviña A, Dawes M, Barber CEH, Esdaile J, Shojania K, Koehn CL, Hoens A, Mcquitty S, Singh S, Yap J, Page D, Kur J, Hobson B, Price M, Lacaille D. POS0303 PREVENTION OF CHRONIC DISEASES DUE TO INFLAMMATION IN INFLAMMATORY ARTHRITIS: RESULTS OF A DELPHI PROCESS TO SELECT CARE RECOMMENDATIONS FOR AN ELECTRONIC MEDICAL RECORD (EMR) INTERVENTION. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2093] [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:Inflammatory arthritis (IA) predisposes patients to several chronic conditions including cardiovascular diseases (CVD), diabetes (DM), osteoporosis (OP) and infections, likely due to systemic effects of inflammation. Studies have found that patients with IA often receive suboptimal care for screening and managing these conditions.Objectives:This is the first phase of a study which will develop and pilot test automated EMR reminders for family physicians. The reminders will prompt family physicians to screen for and address risk factors for these conditions. We conducted a Delphi process to select care recommendations to be addressed by the EMR reminders.Methods:We conducted a review of current BC, Canadian and international guidelines for screening and addressing risk factors for CVD, DM, OP and infection. A list of 22 care recommendations, including their level of evidence and risks/benefits of implementation, was reviewed by a panel of six family physicians, three rheumatologists and three IA patients, in a three-round online modified Delphi process. Panelists rated each care recommendation, using 9-point scales, on 1) their clinical importance, 2) their likelihood of improving outcomes, and 3) implementation feasibility. Results were discussed in an online forum. Panelists then rated slightly revised care recommendations, modified based on feedback from the discussion. Care recommendations were retained if the median rating was ≥7 with no disagreement as defined by the RAND/UCLA Method handbook.Results:A list of 15 care recommendations was selected by the Delphi process for EMR integration, including recommendations that address CVD risk assessment (1), hypertension screening (1), DM screening (2), fracture risk assessment (1), BMD testing (1), osteoporosis prevention (1) and treatment (1) with bisphosphonates, preventing infections through immunization (2), minimizing steroids (1) and hepatitis screening (1), screening for hydroxychloroquine retinal toxicity (1), and counselling for lifestyle modifications (2). We excluded 7 recommendations which addressed lipid testing (1), BMD testing in steroid users (1), immunizations (2), weight management (1), and DMARD laboratory test monitoring (2). Recommendations were excluded on the basis of importance (1) or feasibility (6).Conclusion:The results of the Delphi process will inform the development of reminders, integrated in EMRs, that will support family physicians in their efforts to engage IA patients in addressing risk factors for chronic diseases related to inflammation. We hope to improve the prevention of these diseases, which represent an important cause of morbidity and mortality for people with inflammatory arthritis.Acknowledgements:Iman Sheriff’s work on this project was funded by the CRA summer studentship programme. Dr. Lacaille is supported by the Mary Pack Chair in Arthritis Research from UBC and The Arthritis Society of Canada. Thank you to all who participated in the Delphi survey.Disclosure of Interests:None declared
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Umaefulam V, Loyola-Sanchez A, Bear Chief V, Rame A, Crane L, Kleissen T, Crowshoe L, White T, Lacaille D, Barnabe C. Arthritis liaison: a First Nations community-based patient care facilitator. Health Promot Chronic Dis Prev Can 2021; 41:194-198. [PMID: 34164971 DOI: 10.24095/hpcdp.41.6.04] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Arthritis is a leading cause of disability in First Nations communities and is often accompanied by other chronic diseases. Existing care models prioritize accessibility to specialty care for treatment, whereas patient-centred approaches support broader health goals. METHODS A patient care facilitator model of care, termed "arthritis liaison," was developed with the community to support culturally relevant patient-centred care plans. Following a one-year-long intervention, we report on the feasibility and acceptability of this care model from the perspectives of patients and health care providers. RESULTS The arthritis liaison served as a bridge between the clinicians and patients, and fostered continuity, helping patients receive coordinated care within the community.
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Affiliation(s)
- Valerie Umaefulam
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Ana Rame
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Tessa Kleissen
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden Crowshoe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tyler White
- Siksika Health Services, Siksika, Alberta, Canada
| | - Diane Lacaille
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Cheryl Barnabe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
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Hassen N, Lacaille D, Xu A, Sidi S, Alandejani A, Mansourian M, Sarrazadegan N, Kopec J. POS1427 NATIONAL BURDEN OF RHEUMATOID ARTHRITIS IN CANADA 1990-2017: FINDINGS FROM THE GLOBAL BURDEN OF DISEASE STUDY 2017. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1927] [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:According to the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, over 120,000 individuals currently have rheumatoid arthritis (RA) in Canada, yet a study that evaluates the combined effect of RA on the longevity and quality of life in the country is lacking.Objectives:The objectives of this study are three: 1) to describe burden of RA levels and trends from 1990-2017 using GBD data, 2) to describe age and sex differences, and 3) to compare Canada RA burden to other countries.Methods:We obtained publicly available data from GBD Study 2017 from the Institute for Health Metrics and Evaluation interactive visualization tool (http://vizhub.healthdata.org/gbd-compare). Disease burden indicators include prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Estimates were presented as non age-standardized and age-standardized rates per 100,000 population. GBD estimated prevalence using published literature, survey data, patient records, and health insurance claims, and mortality using cause of death ensemble modelling technique. YLLs measure premature death calculated as the sum of each death multiplied by the standard life expectancy at each age. YLDs measure amount of time in a year an individual lives with a short- or long-term health condition, calculated by combining prevalence with disability weights for each age/sex/year. DALYs were calculated as the sum of YLLs and YLDs. DALYs for Canada were compared to DALYs of countries with similar socio-demographic index (SDI) values. SDI combines income per capita, average educational attainment, and fertility rates. Data were analysed by DisMod-MR 2.1, a Bayesian meta-regression tool.Results:In Canada, RA mortality (mortality and YLLs) improved over time, with a steeper decline after the year 2002. However, the population burden of quality of life (YLDs and DALYs) increased due to increasing prevalence. The disease burden was higher in females (prevalence, mortality, YLLs, YLDs, DALYs), and DALY rates were higher among older populations. Compared to other countries, Canada had greater improvement in mortality and YLLs over time and had a lower age-standardized DALYs rate compared to countries of similar SDI values. A weak association was found between global age-standardized DALYs and SDI (R2 = 0.0138).Conclusion:RA is a major public health challenge. Canada fares better than other countries with regards to national RA burden. Early identification and management are critical to reducing the overall burden of RA in Canada, especially in women. More data from multiple provincial RA databases would increase the accuracy of our estimates for Canada.References:[1]Cross M, Smith E, Hoy D, et al. The global burden of rheumatoid arthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(7):1316-1322. doi:10.1136/annrheumdis-2013-204627[2]Myasoedova E, Davis JM 3rd, Crowson CS, Gabriel SE. Epidemiology of rheumatoid arthritis: rheumatoid arthritis and mortality. Curr Rheumatol Rep. 2010;12(5):379-385. doi:10.1007/s11926-010-0117-y[3]Safiri S, Kolahi AA, Hoy D, et al. Global, regional and national burden of rheumatoid arthritis 1990-2017: a systematic analysis of the Global Burden of Disease study 2017. Ann Rheum Dis. 2019;78(11):1463-1471. doi:10.1136/annrheumdis-2019-215920Acknowledgements:Nejat Hassen is supported by a grant from the Canadian Institute of Health Research. Dr. Diane Lacaille is supported by the Mary Pack Chair in Arthritis Research from the University of British Columbia and The Arthritis Society of Canada.Disclosure of Interests:None declared
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Mills S, Khehra K, Ghuman P, Au D, Koehn CL, Maynard R, Clark N, Davis C, Cui A, Hamilton CB, Lacaille D. POS0298 UNDERSERVED POPULATIONS IDENTIFY BARRIERS AND PROPOSE SOLUTIONS FOR SELF-MANAGING ARTHRITIS AND CHRONIC CONDITIONS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2211] [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:Underserved populations, such as ethnic minorities, low-income adults, and Indigenous people living with arthritis are more likely to have lower health literacy, higher rates of multi-morbidity, and face challenges in accessing care1-3. Self-management support (SMS) can help to mitigate the impacts of living with arthritis4. However, we require a more in-depth understanding of the daily barriers underserved communities face in living with arthritis in order to develop effective SMS that can meaningfully improve well-being and quality of life.Objectives:The study objective was to bring together underserved people living with arthritis to identify common barriers they face in taking care of their conditions in daily life, and to identify their solutions to the identified challenges.Methods:A team of researchers from several universities, nurse practitioners, physicians, policy makers, an arthritis consumer-patient leader and our community partners (Multi-lingual Orientation Service Association for Immigrant Communities and the Portland Hotel Society Community Services Society) engaged in a Community-based Participatory and Concept Mapping (CM) study5-7 where participants from underserved communities identified major barriers they face in managing arthritis, agreed on key themes that emerged, and determined priorities for actions. This involved three key CM activities: 1) brainstorming ideas; 2) sorting and rating ideas; and 3) analyzing and interpreting concept maps8. Data was collected through face-to-face interviews and prioritized and interpreted in workshop settings.Results:Sixty-three individuals who were ethnic minorities, immigrants, refugees, low-income, over 65, and/or housing insecure and living with arthritis identified 35 common barriers and made recommendations in the areas of financial difficulties, social services, access to health services, quality of health services, lack of knowledge, and mental health. Additional funding has been sought through Community-University Engagement Support Funding to enable our community partners to prioritize the recommendations in their communities, and to develop mechanisms for implementation using already existing community structures, processes, and services.Conclusion:Persons living with arthritis in diverse underserved communities face significant health and social inequities, including lack of access to basic life necessities such as food, housing, employment, and safety, which creates barriers to self-managing arthritis and other chronic conditions in daily life. SMS for these communities needs to address these social and environmental barriers shaping capacity for self-management, and ultimately, quality of life and well-being.References:[1]Ackerman I, Busija L. Access to self-management education, conservative treatment and surgery for arthritis according to socioeconomic status. Best Pr Res Clin Rheumatol. 2012;26(5):561–83.[2]Shadmi E. Multimorbidity and equity in health. Int J Equity Heal. 2013;12(59):59.[3]Foster M, Kendall E, Dickson P, Chaboyer W, Hunter B, Gee T. Participation and chronic disease self-management: are we risking inequitable resource allocation? Aust J Prim Health. 2003;9(3):132–40.[4]Brady T, Anderson L, Kobau R. Chronic disease self-management support: public health perspectives. Front Public Heal. 2015;2(234).[5]Trochim W. An introduction to concept mapping for planning and evaluation. Eval Progr Plann. 1989;12(1):1–16.[6]Anderson L, Day K, Vandenberg A. Using a concept map as a tool for strategic planning: the healthy brain initiative. Prev Chronic Dis. 2011;8(5):A117.[7]Petrucci C, Quinlan K. Bridging the research practice gap: concept mapping as a mixed methods strategy in practice-based research and evaluation. J Soc Serv Res. 2007;34(2):25–42.[8]Kane M, Trochim W. Concept mapping for planning and evaluation. Thousand Oaks (CA): SAGE Publications; 2007.Disclosure of Interests:None declared
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Barber CEH, Marshall DA, Szefer E, Barnabe C, Shiff NJ, Bykerk V, Homik J, Thorne JC, Ahluwalia V, Benseler S, Mosher D, Twilt M, Lacaille D. A Population-Based Approach to Reporting System-Level Performance Measures for Rheumatoid Arthritis Care. Arthritis Care Res (Hoboken) 2021; 73:640-648. [PMID: 32144843 DOI: 10.1002/acr.24178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/25/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To operationalize and report on nationally endorsed rheumatoid arthritis (RA) performance measures (PMs) using health administrative data for British Columbia (BC), Canada. METHODS All patients with RA in BC ages ≥18 years were identified between January 1, 1997 and December 31, 2009 using health administrative data and followed until December 2014. PMs tested include: the percentage of incident patients with ≥1 rheumatologist visit within 365 days; the percentage of prevalent patients with ≥1 rheumatologist visit per year; the percentage of prevalent patients dispensed disease-modifying antirheumatic drug (DMARD) therapy; and time from RA diagnosis to DMARD therapy. Measures were reported on patients seen by rheumatologists, and in the total population. RESULTS The cohort included 38,673 incident and 57,922 prevalent RA cases. The percentage of patients seen by a rheumatologist within 365 days increased over time (35% in 2000 to 65% in 2009), while the percentage of RA patients under the care of a rheumatologist seen yearly declined (79% in 2001 to 39% in 2014). The decline was due to decreasing visit rates with increasing follow-up time rather than calendar effect. The percentage of RA patients dispensed a DMARD was suboptimal over follow-up (37% in 2014) in the total population but higher (87%) in those under current rheumatologist care. The median time to DMARD in those seen by a rheumatologist improved from 49 days in 2000 to 23 days in 2009, with 34% receiving treatment within the 14-day benchmark. CONCLUSION This study describes the operationalization and reporting of national PMs using administrative data and identifies gaps in care to further examine and address.
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Affiliation(s)
- Claire E H Barber
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Deborah A Marshall
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | - Cheryl Barnabe
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | - Vivian Bykerk
- Hospital for Special Surgery and Cornell University, New York, New York
| | - Joanne Homik
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Susanne Benseler
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | | | - Marinka Twilt
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Richmond, and University of British Columbia, Vancouver, British Columbia, Canada
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Yazdani K, Xie H, Avina-Zubieta JA, Zheng Y, Abrahamowicz M, Lacaille D. Ten-year risk of cerebrovascular accidents in incident rheumatoid arthritis: a population-based study of trends over time. Rheumatology (Oxford) 2021; 60:2267-2276. [PMID: 33246339 DOI: 10.1093/rheumatology/keaa579] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/22/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate secular trends in 10-year risk of incident cerebrovascular accidents (CVA), in incident RA relative to the general population. METHODS We conducted a retrospective study of a population-based incident cohort with RA onset from 1997 to 2004 in British Columbia, Canada, with matched general population controls (2:1), using administrative health data. RA and general population cohorts were divided according to year of RA onset, defined according to the first RA visit of the case definition. Incident CVA was defined as the first CVA occurring within 10 years from the first RA visit. Secular trend was assessed using delayed-entry Cox models with a two-way interaction term between the year of RA onset and indicator of RA vs general population. Linear, quadratic and spline functions of year of RA onset were compared with assess non-linear effects. The model with the lowest Akaike Information Criterion was selected. RESULTS Overall, 23 545 RA and 47 090 general population experienced 658 and 1220 incident CVAs, respectively. A spline Cox model with a knot at year of onset 1999 was selected. A significant decline in risk of CVA was observed in individuals with RA onset after 1999 [0.90 (0.86, 0.95); P = 0.0001]. The change in CVA risk over time differed significantly in RA with onset from 1999 onwards compared with the general population (P-value of interaction term = 0.03), but not before 1999 (P = 0.06). CONCLUSION Our findings suggest that people with RA onset from 1999 onwards, had a significantly greater decline in 10-year risk of CVA compared with the general population.
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Affiliation(s)
- Kiana Yazdani
- Arthritis Research Canada, Richmond.,Department of Medicine, Faculty of Medicine, Experimental Medicine Program, University of British Columbia, Vancouver
| | - Hui Xie
- Arthritis Research Canada, Richmond.,Faculty of Health Sciences, Simon Fraser University, Vancouver
| | - J Antonio Avina-Zubieta
- Arthritis Research Canada, Richmond.,Department of Medicine, Faculty of Medicine, Experimental Medicine Program, University of British Columbia, Vancouver.,Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | | | - Michal Abrahamowicz
- Arthritis Research Canada, Richmond.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Richmond.,Department of Medicine, Faculty of Medicine, Experimental Medicine Program, University of British Columbia, Vancouver.,Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
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Khan N, Palepu A, Dodek P, Salmon A, Leitch H, Ruzycki S, Townson A, Lacaille D. Cross-sectional survey on physician burnout during the COVID-19 pandemic in Vancouver, Canada: the role of gender, ethnicity and sexual orientation. BMJ Open 2021; 11:e050380. [PMID: 33972345 PMCID: PMC8111871 DOI: 10.1136/bmjopen-2021-050380] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine the prevalence of physician burnout during the pandemic and differences by gender, ethnicity or sexual orientation. DESIGN, SETTING AND PARTICIPANTS We conducted a cross-sectional survey (August-October in 2020) of internal medicine physicians at two academic hospitals in Vancouver, Canada. PRIMARY AND SECONDARY OUTCOMES Physician burnout and its components, emotional exhaustion, depersonalisation and personal accomplishment were measured using the Maslach Burnout Inventory. RESULTS The response rate was 38% (n=302/803 respondents, 49% women,). The prevalence of burnout was 68% (emotional exhaustion 63%, depersonalisation 39%) and feeling low personal accomplishment 22%. In addition, 21% reported that they were considering quitting the profession or had quit a position. Women were more likely to report emotional exhaustion (OR 2.00, 95% CI: 1.07 to 3.73, p=0.03) and feeling low personal accomplishment (OR 2.26, 95% CI: 1.09 to 4.70, p=0.03) than men. Visible ethnic minority physicians were more likely to report feeling lower personal accomplishment than white physicians (OR 1.81, 95% CI: 1.28 to 2.55, p=0.001). There was no difference in emotional exhaustion or depersonalisation by ethnicity or sexual orientation. Physicians who reported that COVID-19 affected their burnout were more likely to report any burnout (OR: 3.74, 95% CI: 1.99 to 7.01, p<0.001) and consideration of quitting or quit (OR: 3.20, 95% CI: 1.34 to 7.66, p=0.009). CONCLUSION Burnout affects 2 out of 3 internal medicine physicians during the pandemic. Women, ethnic minority physicians and those who feel that COVID-19 affects burnout were more likely to report components of burnout. Further understanding of factors driving feelings of low personal accomplishment in women and ethnic minority physicians is needed.
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Affiliation(s)
- Nadia Khan
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anita Palepu
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Dodek
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Amy Salmon
- Center for Health Evaluation and Outcomes Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather Leitch
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Shannon Ruzycki
- Department of Medicine, Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Andrea Townson
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Department of Medicine, Arthritis Research Canada, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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49
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Li L, Lu N, Avina-Galindo AM, Zheng Y, Lacaille D, Esdaile JM, Choi HK, Aviña-Zubieta JA. The risk and trend of pulmonary embolism and deep vein thrombosis in rheumatoid arthritis: a general population-based study. Rheumatology (Oxford) 2021; 60:188-195. [PMID: 32617563 DOI: 10.1093/rheumatology/keaa262] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 01/16/2020] [Revised: 04/21/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To estimate the overall risk of venous thromboembolism (VTE), pulmonary embolism (PE) and deep vein thrombosis (DVT) among patients newly diagnosed with RA compared with the general population without RA; and to estimate the risk trends of VTE, PE and DVT after RA diagnosis up to 5 years compared with the general population. METHODS Using previously validated RA case definition, we conducted a matched cohort study using the population-based administrative health database from the province of British Columbia, Canada. We calculated incidence rates (IRs) and fully adjusted hazard ratios (HRs) for the risk of VTE, DVT and PE after RA index date. RESULTS Among 39 142 incident RA patients (66% female, mean age 60), 1432, 543 and 1068 developed VTE, PE and DVT, respectively. IRs for the RA cohort were 3.79, 1.43 and 2.82 per 1000 person-years vs 2.70, 1.03 and 1.94 per 1000 person-years for the non-RA cohort. After adjusting for VTE risk factors, the HRs (95% CI) were 1.28 (1.20, 1.36), 1.25 (1.13, 1.39) and 1.30 (1.21, 1.40) for VTE, PE and DVT, respectively. The fully adjusted HRs for VTE during the first five years after RA diagnosis were 1.60, 1.47, 1.40, 1.30 and 1.28, respectively. A similar trend was shown in PE. CONCLUSION This population-based study demonstrates that RA patients have an increased risk of VTE, PE and DVT after diagnosis compared with the general population. This risk is independent of traditional VTE risk factors and is highest during the first year after RA diagnosis, then progressively declined.
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Affiliation(s)
- Lingyi Li
- Arthritis Research Canada, Richmond.,Experimental Medicine Program
| | - Na Lu
- Arthritis Research Canada, Richmond
| | | | | | - Diane Lacaille
- Arthritis Research Canada, Richmond.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - John M Esdaile
- Arthritis Research Canada, Richmond.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Hyon K Choi
- Arthritis Research Canada, Richmond.,Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Richmond.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
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50
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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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