Background Colchicine may have beneficial effects on cardiovascular (CV) disease, but there are sparse data on its CV effect among patients with gout. We examined the potential association between colchicine and CV risk and all-cause mortality in gout. Methods The analyses used data from an electronic medical record (EMR) database linked with Medicare claims (2006–2011). To be eligible for the study cohort, subjects must have had a diagnosis of gout in the EMR and Medicare claims. New users of colchicine were identified and followed-up from the first colchicine dispensing date. Non-users had no evidence of colchicine prescriptions during the study period and were matched to users on the start of follow-up, age, and gender. Both groups were followed for the primary outcome, a composite of myocardial infarction (MI), stroke or transient ischemic attack (TIA). We calculated hazard ratios (HRs) in Cox regression, adjusting for potential confounders. Results We matched 501 users with an equal number of non-users with a median follow-up of 16.5 months. During follow-up, 28 primary CV events were observed among users and 82 among non-users. Incidence rates per 1,000 person-years were 35.6 for users and 81.8 for non-users. After full adjustment, colchicine use was associated with a 49% lower risk (HR 0.51, 95% CI 0.30 – 0.88) in the primary CV outcome as well as a 73% reduction in all-cause mortality (HR 0.27, 95% CI 017 – 0.43). Conclusion Colchicine use was associated with a reduced risk of a CV event among patients with gout.
Background Treat to target (TTT) is an accepted paradigm for management of rheumatoid arthritis (RA), but some evidence suggests poor adherence. We tested the effects of a group-based multi-site improvement Learning Collaborative (LC) on adherence to TTT. Methods We conducted a cluster-randomized quality improvement trial with wait-list control across 11 rheumatology sites in the US. The intervention entailed a 9-month group-based LC that incorporated rapid-cycle improvement methods. A composite TTT implementation score was a percentage of four required items documented in the visit notes for each patient at two time points, as evaluated by trained staff. The mean change in the implementation score for TTT across all patients for intervention sites was compared with control sites after accounting for intra-cluster correlation using linear mixed models. Results Five sites with a total of 23 participating rheumatology providers were randomized to intervention and six sites with 23 participating rheumatology providers were randomized to the wait-list control. The intervention included 320 patients and the control 321 patients. At baseline, the mean TTT implementation score was 11% in both arms; after the 9-month intervention, the TTT implementation score was 57% in intervention and 25% in control (change in score of 46% in the intervention arm and 14% in control; p = 0.004). We did not observe excess resource use or excess adverse events in the intervention arm. Conclusions An LC resulted in substantial improvements in adherence to TTT for management of RA. This study supports the use of an educational collaborative to improve quality.
An elevated disease activity measure not reflective of RA disease activity and patient preference are the two leading barriers to treatment adjustment to TTT in RA. Understanding barriers to adherence should guide interventions aimed at using better markers of disease activity and improving alignment with patient preference, with the overarching goal of enhancing TTT adherence.
Objective. Patient registries have contributed substantially to progress in clinical research in rheumatic diseases. However, not much is known about how to optimize the patient experience in such registries. We assessed patient views, motivations, and potential barriers towards participation in registry research to better understand how registries can be improved to maximize patient engagement. Methods. Focus groups were held with 23 patients (mean 6 SD age 59 6 13 years) from the Boston area and led by a bilingual moderator trained in focus group methodology, using a semistructured moderator guide. Three separate focus groups were conducted to thematic saturation: patients with rheumatoid arthritis (RA) who had registry experience, patients with any chronic illness, and Spanish-speaking patients with RA or osteoarthritis. Patients in the latter 2 groups had no prior registry experience. Focus groups were audiotaped and transcribed. Four researchers independently analyzed transcripts using open data coding to identify themes. A normative group process was used to consolidate and refine themes. Results. Seven major themes were identified, including personalization/convenience of data collection, trust and confidentiality, camaraderie, learning about yourself and your disease, altruism, material motivators, and capturing mental health and other elements of the lived experience. We observed distinct differences in the discussion content of the Spanish-speaking patients compared to the English-speaking patients. Conclusion. This study identified patient attitudes towards registry research among those with and without prior experience in a registry. The results provide insight into strategies for registry design to maximize patient engagement, which can lead to more robust registry data.
Background/Purpose Treat to target (TTT) is a recommended strategy in the management of rheumatoid arthritis (RA), but various data sources suggest that its uptake in routine care in the US is sub-optimal. Herein, we describe the design of a randomized controlled trial of a Learning Collaborative to facilitate implementation of TTT. Methods We recruited 11 rheumatology sites from across the US and randomized them into two groups: one received the Learning Collaborative intervention in Phase 1 (month 1–9) and the second formed a wait-list control group to receive the intervention in Phase 2 (months 10–18). The Learning Collaborative intervention was designed using the Model for Improvement, consisting of a Change Package with corresponding principles and action phases. Phase 1 intervention practices had 9 learning sessions, collaborated using a web-based tool, and shared results of plan-do-study-act cycles and monthly improvement metrics collected at each practice. The wait-list control group sites had no intervention during Phase 1. The primary trial outcome is implementation of TTT as measured by chart review, comparing the differences from baseline to end of Phase 1, between intervention and control sites. Results All intervention sites remained engaged in the Learning Collaborative throughout Phase 1, with a total of 38 providers participating. The primary trial outcome measures are currently being collected by the study team through medical record review. Conclusions If the Learning Collaborative is an effective means for improving implementation of TTT, this strategy could serve as a way of implementing disseminating TTT more widely.
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