AB0810 Assessing Healthcare Utilization in Patients with Axial Spondyloarthritis. Results from the Spanish Atlas

Abstract

BackgroundHealthcare utilization by patients with axial spondyloarthritis (axSpA) is substantial, leading to a considerable social and economic burden1. Understanding patients’ characteristics and the main determinants of healthcare utilization is essential to reduce this burden.ObjectivesThe aim of the present study is to assess healthcare utilization in patients with axSpA in Spain.MethodsData from an online survey of 680 unselected axSpA patients pertaining to the Spanish Atlas of Axial Spondyloarthritis were analysed. Total healthcare utilization was assessed as the sum of number of healthcare visits, medical tests, hospital admissions, and emergency visits, all relying on the last 12 months prior to the survey. Mann-Whitney and Pearson’s χ2 tests were used to analyse possible associations between sociodemographic (age, gender, educational level, marital status, and patient organizations membership) and patient-reported outcomes (disease activity measured by BASDAI [0-10], mental health measured by GHQ-12 [0-12], functional limitation index (0-54), spinal stiffness index (3-12), and diagnostic delay) with respect to total healthcare utilization. Simple and multiple linear regression was used to analyse its possible associated factors.ResultsA total of 530 axSpA patients participated in this study: the mean age was 45.3 years, 51.1% were female, 39.6% had a university degree, and 70.6% were married. In the previous 12 months, 77.9% (n= 530) used at least one healthcare source, of which 75.3% visited at least once a rheumatologist (n= 512, mean= 4.4), 55.6% GP (n= 378, mean= 9.4) and 33.5% physiotherapist (n= 228, mean= 20.1). With respect to medical tests performed in the last 12 months, 75.3% performed at least one x-rays test (n= 512, mean= 4.4) and 71.2% blood test (n= 484, mean= 4.5). Furthermore, 7.9% of patients were hospitalised (n= 54, mean= 2.2 and 23.1% of patients visited outpatient centre (n= 157, mean= 5.5).Younger patients (r= -0.195) and females (52.0 vs 32.2 of males) showed higher healthcare utilization (p<0.001). In addition, a low positive correlation was found between healthcare utilization and disease activity (r= 0.290), mental health (r= 0.257), functional limitation (r= 0.283) and diagnostic delay (r= 0.151), all p-values <0.001.In the multiple linear regression, the qualitative factors associated with higher healthcare utilization was female gender (B= 12.854), while the quantitative factors associated with high healthcare utilization were younger age (B= -0.737), higher disease activity (B= 3.378), greater functional limitation (B= 0.576), and longer diagnostic delay (B= 0.959; Table 1).Table 1.Linear regression analysis of socio-demographic and patient-reported outcomes according to healthcare utilization (N= 402)Simple linear regressionMultiple linear regressionBeta95% CIBeta95% CIAge-0.884-1,266, -0.503-0.737-1.190, -0.283Gender. Female19.79211.600, 27.98412.8543.502, 22.207BASDAI (0-10)7.2604.934, 9.5863.3780,571, 6.185GHQ-12 (0-12)2.7241.786, 3.6631.126-0.048, 2.300Functional Limitation (0-54)1.4181.007, 1.8280.5760.007, 1.145Diagnostic Delay0.9660.419, 1.5120.9590.374, 1.544ConclusionHigher healthcare utilization was associated with higher disease activity, greater functional limitation, and longer diagnostic delay, in younger and females axSpA patients. Optimal monitoring of axSpA patients may help to minimise healthcare utilisation in patients with axSpA.