Abstract
ObjectiveTo determine the frequency of lost to follow-up (LTFU) in the setting of usual care for outpatients with rheumatic diseases including RA, SLE, AS, and Ps/PsA, to explore the associated demographic factors, and to investigate the reasons for being LTFU from the original medical care.MethodsPatients registered between May 2011 and January 2014 at the rheumatology outpatient department of a medical center were included. Those who did not attend their scheduled appointment were defined as LTFU. Univariate and multivariate logistic regression were used to analyze the factors for being LTFU.ResultsA total of 781 patients were enrolled, including 406 patients with RA, 174 with SLE, 136 with AS, and 65 with Ps/PsA. The frequency of LTFU was 23.9%, 25.9%, 35.3%, and 35.4%, respectively. The frequency of LTFU was significantly different between the four rheumatic diseases (p = 0.028). In multivariate logistic regression analysis, an older age increased being LTFU in the patients with RA (OR 1.02; 95% CI 1.00–1.04; p = 0.033), but reduced being LTFU in those with Ps/PsA (OR 0.96; 95% CI 0.92–0.99; p = 0.021). Female patients with SLE and Ps/PsA were more likely to be LTFU, although this did not reach statistical significance (p = 0.056 and 0.071, respectively). The most common reason for being LTFU was moving to other district hospitals from the original medical center due to convenience for the patients with RA and SLE, and stopping medication due to minimal symptoms for the patients with AS and Ps/PsA.ConclusionsThe frequency of LTFU in patients with rheumatic diseases is high. Associated demographic factors included older age in RA, female gender in SLE and Ps/PsA, and younger age in Ps/PsA, with various reasons for being LTFU. Recognizing these associated factors and reasons for being LTFU may help to improve the attendance of patients and the quality of medical care.
Highlights
For the majority of rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS), and psoriasis/psoriatic arthritis (Ps/PsA), current therapeutic regimes have been shown to slow disease progression [1,2,3,4]
Lost to Follow-Up in Patients with Rheumatic Diseases age in Ps/PsA, with various reasons for being lost to follow-up (LTFU). Recognizing these associated factors and reasons for being LTFU may help to improve the attendance of patients and the quality of medical care
Patients who are lost to follow-up (LTFU) without returning for continuous care may contribute to a considerable worsening of the disease, leading to organ damage and an increase in health care expenditure in many chronic diseases [8,9], including rheumatic diseases [10,11,12]
Summary
For the majority of rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS), and psoriasis/psoriatic arthritis (Ps/PsA), current therapeutic regimes have been shown to slow disease progression [1,2,3,4]. Regular outpatient follow-up with medication and continuous monitoring of disease activity are required for successful control of the disease, and to prevent advanced organ damage [5,6]. The failure of patients to maintain regular follow-up is a major problem for clinical physicians [7]. Patients who are lost to follow-up (LTFU) without returning for continuous care may contribute to a considerable worsening of the disease, leading to organ damage and an increase in health care expenditure in many chronic diseases [8,9], including rheumatic diseases [10,11,12]. LTFU has emerged as a key indicator of treatment effectiveness
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