Rheumatoid Arthritis Surveillance in Ontario: Monitoring the Burden, Quality of Care and Patient Outcomes through Linkage of Administrative Health Data

Widdifield, Jessica; Bernatsky, Sasha; Bombardier, Claire; Paterson, Michael

doi:10.12927/hcq.2015.24439

Cited by 12 publications

(13 citation statements)

References 18 publications

(25 reference statements)

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“…Cohort selection. We identified patients with RA within the Ontario Rheumatoid Arthritis Dataset 18 . Our analyses were confined to individuals who had at least 3 physician service claims with an RA diagnosis (with at least 1 provided by a musculoskeletal specialist) within 2 years.…”

Section: Methodsmentioning

confidence: 99%

Associations Between Methotrexate Use and the Risk of Cardiovascular Events in Patients with Elderly-onset Rheumatoid Arthritis

Widdifield

Abrahamowicz²,

Paterson³

et al. 2018

J Rheumatol

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Objective.We evaluated the associations between time-varying methotrexate (MTX) use and risk of cardiovascular events (CVE) in patients with rheumatoid arthritis (RA).Methods.We studied an inception cohort of 23,994 patients with RA diagnosed after their 65th birthday. Multivariable Cox regression models were fit to evaluate the associations between time-varying MTX use, controlling for other risk factors, and time to CVE. Alternative models assessed the cumulative duration of MTX use over the (1) first year, (2) previous year (recent use), and (3) entire duration of followup. We also assessed whether the strength of the association varied over time.Results.Over 115,453 patient-years (PY), 3294 (13.7%) patients experienced a CVE (28.5 events per 1000 PY; 95% CI 27.6–29.5). In the multivariable analyses, the model assessing time-varying continuous use in the most recent year yielded the best fit. Increasing recent MTX use was associated with lower CVE risks (HR 0.79 for continuous use vs no use in past 12 months, 95% CI 0.70–0.88; p < 0.0001). Greater MTX use in the first year after cohort entry was also protective (HR 0.84, 95% CI 0.72–0.96; p = 0.0048), but this effect decreased with increasing followup. In contrast, longer MTX use during the entire followup was not clearly associated with CVE risk (HR 0.98, 95% CI 0.95–1.01; p = 0.1441).Conclusion.We observed about a 20% decrease in CVE associated with recent continuous MTX use. Greater MTX use in the first year of cohort entry also appeared to be important in the association between MTX and CVE risk.

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Section: Methodsmentioning

confidence: 99%

Associations Between Methotrexate Use and the Risk of Cardiovascular Events in Patients with Elderly-onset Rheumatoid Arthritis

Widdifield

Abrahamowicz²,

Paterson³

et al. 2018

J Rheumatol

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“…A strength of the ERP-triage model was the clinically significant reduction in time-to-treatment-decision for those patients with suspected IA. Early treatment reduces patient suffering, reduces joint damage, improves mobility and function, and also has significant fiscal implications to patients, their families, and to society 1–7,32,33…”

Section: Discussionmentioning

confidence: 99%

“…Early intervention with a treatment decision within 6 weeks of referral in patients with suspected RA1 is directly related to improved clinical outcomes, functional status, and a higher quality of life 2–6. In Ontario, only 38% of patients with RA are currently meeting this benchmark for first point of contact with a rheumatologist 7. Fewer than 50% receive a DMARD within 6 months of symptom onset 8…”

Section: Introductionmentioning

confidence: 99%

An advanced clinician practitioner in arthritis care can improve access to rheumatology care in community-based practice

Ahluwalia¹,

Larsen²,

Kennedy

et al. 2019

JMDH

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ObjectiveTo facilitate access and improve wait times to a rheumatologist’s consultation, this study aimed to 1) determine the ability of an advanced clinician practitioner in arthritis care (ACPAC)-trained extended role practitioner (ERP) to triage patients with suspected inflammatory arthritis (IA) for priority assessment by a rheumatologist and 2) determine the impact of an ERP on access-to-care as measured by time-to-rheumatologist-assessment and time-to-treatment-decision.Materials and methodsA community-based ACPAC-trained ERP triaged new referrals for suspected IA. Patients with suspected IA were booked to see the rheumatologist on a priority basis. Diagnostic accuracy of the ERP to correctly identify priority patients; the level of agreement between ERP and rheumatologist (Kappa coefficient and percent agreement); and the time-to-treatment-decision for confirmed cases of IA were investigated. Retrospective chart review then compared time-to-rheumatologist-assessment and time-to-treatment-decision in the solo-rheumatologist versus the ERP-triage model.ResultsOne hundred twenty-one patients were triaged. The ERP designated 54 patients for priority assessment. The rheumatologist confirmed IA in 49/54 (90.7% positive predictive value [PPV]). Of the 121 patients, 67 patients were designated as nonpriority by the ERP, and none were determined to have IA by the rheumatologist (100% negative predictive value [NPV]). Excellent agreement was found between the ERP and the rheumatologist (Kappa coefficient 0.92, 95% CI: 0.84–0.99). In the ERP-triage model, time-from-referral-to-treatment-decision for patients with IA was 73.7 days (SD 40.4, range 12–183) compared with 124.6 days (SD 61.7, range 26–359) in the solo-rheumatologist model (40% reduction in time-to-treatment-decision).ConclusionA well-trained and experienced ERP can shorten the time-to-Rheumatologist-assessment and time-to-treatment-decision for patients with suspected IA.

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“…This has an implication to the definition of RA, since every encounter with a physician may not be recorded in the OHIP data set. Since the ODB routinely captures claims for prescription drugs for people 65 years and older only, the study cohort is limited to that age group, which represents 44% of RA patients in Ontario as of 2010 10. Furthermore, ICES does not have data on prescriptions paid out of pocket or by private insurance companies, which could underestimate the use of biologic DMARDs and also makes distinguishing between biologic naïve and biologic experienced patients impossible.…”

Section: Discussionmentioning

confidence: 99%

Impact of adherence to biological agents on health care resource utilization for patients over the age of 65 years with rheumatoid arthritis

Lathia¹,

Ewara²,

Nantel³

2017

PPA

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ObjectivePoor adherence to therapy increases the patient and societal burden and complexity of chronic diseases such as rheumatoid arthritis (RA). In the past 15 years, biologic disease-modifying anti-rheumatic drugs (DMARDs) have revolutionized the treatment of RA. However, little data are available on the impact of adherence to biologics on health care resources. The objective of the study was to determine the long-term health care resource utilization patterns of RA patients who were adherent to biologic DMARD therapy compared to RA patients who were non-adherent to biologic DMARD therapy in an Ontario population and to determine factors influencing adherence.MethodsPatients were identified from the Ontario RA Database that contains all RA patients in Ontario, Canada, identified since 1991. The study population included RA patients, aged 65+ years, with a prescription for a biologic DMARD between 2003 and 2013. Exclusion criteria included diagnosis of inflammatory bowel disease, psoriatic arthritis or psoriasis in the 5 years prior to the index date and discontinuation of biologic DMARD, defined as no subsequent prescription during the 12 months after the index date. Adherence was defined as a medication possession ratio of ≥0.8 measured as the proportion of days for which a patient had biologic treatment(s) over a defined follow-up period. Adherent patients were matched to non-adherent patients by propensity score matching.ResultsA total of 4,666 RA patients were identified, of whom 2,749 were deemed adherent and 1,917 non-adherent. The age (standard deviation) was 69.9 (5.46) years and 75% were female. Relative rates for resource use (physician visits, emergency visits, hospitalization, home care and rehabilitation) for the matched cohort were significantly lower (P⩽0.0001) in adherent patients. Non-adherent patients’ use of oral prednisone (67%) was significantly higher (P⩽0.001) than that of the adherent cohort (56%).ConclusionRA patients adherent to biologic therapy have lower health care resource use and lower steroid use compared to non-adherent patients.

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Rheumatoid Arthritis Surveillance in Ontario: Monitoring the Burden, Quality of Care and Patient Outcomes through Linkage of Administrative Health Data

Cited by 12 publications

References 18 publications

Associations Between Methotrexate Use and the Risk of Cardiovascular Events in Patients with Elderly-onset Rheumatoid Arthritis

Associations Between Methotrexate Use and the Risk of Cardiovascular Events in Patients with Elderly-onset Rheumatoid Arthritis

An advanced clinician practitioner in arthritis care can improve access to rheumatology care in community-based practice

Impact of adherence to biological agents on health care resource utilization for patients over the age of 65 years with rheumatoid arthritis

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