Session Title: Health Services Research
Session Type: Abstract Submissions (ACR)
Background/Purpose: Inflammatory arthritis (IA: rheumatoid arthritis, systemic lupus erythematosus, and spondyloarthritis) disproportionately affects Canada’s First Nations population. Treatment outcomes may be ameliorated by health service models that mitigate logistical barriers to care and provide specialty services embedded in the primary care context. This study assessed the effectiveness of a specialized care model, delivered in a First Nations primary care setting, in achieving IA activity targets.
Methods: Consenting participants were recruited to an arthritis screening program held in a First Nations community between June 2011 and August 2012. Those determined to have IA (n=47) received ongoing follow-up with collection of disease activity measures and patient-reported outcomes, as well as treatment recommendations, at each visit. Repeated measures ANOVA was used to describe changes in disease activity measures over a 24 month period. The frequency with which a treatment change was recommended, based on moderate or high disease activity state determined from the DAS28, was calculated.
Results: A total of 131 visits by 47 participants (79% female, mean age 47 years, diagnosis of rheumatoid arthritis n=34) occurred over the 24 month study period. At the baseline visit, 70.6% of participants had moderate or high disease activity (DAS28>3.2). Significant decreases in joint counts (/28) were achieved (mean swollen joint count decrease of 7.0, 95% CI 3.5-10.4, p=0.0061; mean tender joint decrease of 7.2, 95% CI 4.1-10.3, p=0.0116). Patient-reported outcomes for pain, global assessment and physical function were not significantly improved during treatment. A recommendation for treatment change was made at 67% of visits where patients were classified in moderate or high disease activity.
Conclusion: Although the program adequately addressed physician-derived disease activity targets, patient-reported outcomes were not significantly improved during follow-up. This suggests that the program should be modified to include a multi-disciplinary team that can address holistic aspects of First Nations health and reduce loss to follow-up from specialty care. A quality improvement initiative will be introduced to document reasons for deviation from the treat-to-target protocol.
D. P. Mosher,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/inflammatory-arthritis-treatment-outcomes-at-a-first-nations-reserve-rheumatology-specialty-clinic/