Abstract
BackgroundRA patients who eventually dropped out of treatment and out of the health care system had potentially disastrous consequences for their health-related quality-of-life outcomes. Objectives of the study were to identify predictors of health care drop out (HDO) in an inception and ongoing cohort of patients with recent onset RA.MethodsCharts from patients attending an early arthritis clinic from February 2004 to December 2015, and standardized follow-up evaluations were reviewed. Patients with HDO (cases) were defined when they did not return back to the clinic for a schedule visit for at least one year. Persistence with therapy was defined as length of time patients complied with RA-treatment. A case-control nested within a cohort design was used to compare baseline and cumulative (up to HDO or equivalent follow-up) variables between cases and paired controls (patients compliant with scheduled visits). Cox regression analysis was used to investigate predictors of HDO. The study was approved by the Institutional Review Board and patients gave written informed consent to have their data published.ResultsData from 170 patients (89.4% female, [mean±SD] age: 38.2±12.6 years) with ≥1 year of follow-up were analyzed; up to December 2015, (median, interquartile rage) follow-up was 86.6 months (43.2–123) during which 35 (20.6%) patients had HDO after 41.1 months (12.1–58.7). Baseline and cumulative variables related to disease activity, treatment and persistence with therapy entered regression models; cumulative number of flares, number of disease-modifying anti-rheumatic drugs /patient and persistence <50% emerged as predictors of HDO. Five cases returned back after (median, range) drop out time of 3.8 years (2.3–5.8); they exhibited higher disability and poorer function than paired controls and outcomes were sustained up to their last follow-up.ConclusionsIn a real clinical setting of an EAC, failure to control disease activity, intensive treatment and poor persistence with therapy predicted HDO. Abandonment of health care had a negative impact on patient outcomes and was sustained even after health care was reinitiated.
Highlights
Rheumatoid arthritis (RA) patients who eventually dropped out of treatment and out of the health care system had potentially disastrous consequences for their health-related quality-of-life outcomes
Characteristics of the study population and comparison of baseline characteristics between cases and controls To December 2015, charts from 172 patients with at least one year of follow-up were reviewed by one single data extractor: 35 were defined as cases and 135 as controls
We found that 20.6% of the patients dropped out of health care, which closely approximates the proportion published by NellDuxneuner et al [26], who reported on a population of 119 patients with inflammatory arthritis of ≤12 weeks’ duration, among whom, 67 had an RA diagnosis
Summary
RA patients who eventually dropped out of treatment and out of the health care system had potentially disastrous consequences for their health-related quality-of-life outcomes. The literature reports a lower prevalence [4], a younger age at presentation [4, 5] and a less severe clinical expression [5] in this population compared with Caucasians These patients are frequently uninsured, have low socioeconomic status and are less educated than RA patients from developed countries [4]. Once enrolled in the inception cohort, patients underwent evaluations scheduled at regular intervals and were prescribed treatment, according to a ‘treat to target’ strategy.
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