1
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Alcaide L, Torralba AI, Eusamio Serre J, García Cotarelo C, Loza E, Sivera F. Current state, control, impact and management of rheumatoid arthritis according to patient: AR 2020 national survey. REUMATOLOGIA CLINICA 2022; 18:177-183. [PMID: 35277215 DOI: 10.1016/j.reumae.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/15/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To analyse current status, control and impact of RA on patients' lives as well as the management of RA symptoms. METHODS A structured anonymous online questionnaire was designed and sent to patients with RA, aged 18 years or above living in Spain. Participants were invited though different strategies: 1) ConArtritis and related patients associations; 2) Patients participating in the platform www.in-pacient.es; 3) Links from ConArtritis website and open social networks. Sociodemographic and clinical variables, as well as others related to the objectives were collected. A descriptive analysis was performed. RESULTS We analysed 882 RA patients, 89% women, with a median age of 52 years, 31.9% disease duration <5 years. They reported a mean pain and patient global disease score (0-10) of 5.1 and 4.9 respectively. The rate of patients with many difficulties or inability to perform daily tasks varied from 6.4% to 49.2%. Based on the activity index 56.8% of patients reported high activity. We found a great or severe impact on the emotional well-being in 31.5% of patients, and of 29.2% in the workplace or academic setting. A total of 87.9% are taking some medication for RA, and 17.3% are little/not satisfied with them. In addition, 67.1% take conventional synthetic disease modifying drugs (DMARDs), and 45.9% biological therapies including biosimilars and small molecules. CONCLUSIONS The current impact of RA on patients' daily lives remains very high. A significant number of patients are not taking DMARDs (conventional synthetic and/or biologics) despite high activity.
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Affiliation(s)
- Laly Alcaide
- Coordinadora Nacional de Artritis, Madrid, Spain
| | | | | | | | | | - Francisca Sivera
- Servicio de Reumatología, Hospital General de Elda, Alicante, Spain.
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2
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Castañeda S, González C, Villaverde V, Lajas Petisco C, Castro MC, Jirout F, Obaya JC, Hermosa JC, Suárez C, García S, Rodero M, León L, López Esteban A, Gobbo M, Alcaide L, Torre-Alonso JC. Development and feasibility of 4 checklists for the evaluation of comorbidity in patients with rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis: GECOAI Project. REUMATOLOGIA CLINICA 2022; 18:114-123. [PMID: 35153034 DOI: 10.1016/j.reumae.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 09/03/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). METHODS A multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients' association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA. RESULTS Four comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice. CONCLUSIONS The use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice.
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Affiliation(s)
- Santos Castañeda
- Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-ROCHE, EPID-Futuro, Universidad Autónoma de Madrid (UAM), Madrid, Spain.
| | - Carlos González
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Cristina Lajas Petisco
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, Spain
| | - María Carmen Castro
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Fernando Jirout
- Servicio de Reumatología, Hospital Monte Naranco, Oviedo, Spain
| | | | | | - Carmen Suárez
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Silvia García
- Servicio de Reumatología, Hospital Moises Broggi, Sant Joan Despí, Barcelona, Spain
| | - María Rodero
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, Spain
| | - Leticia León
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, Spain
| | - Amparo López Esteban
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Milena Gobbo
- Positivamente Centro de Psicología, Madrid, Spain
| | - Laly Alcaide
- Coordinadora Nacional de Artritis, Madrid, Spain
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Pego-Reigosa JM, Peña-Gil C, Rodríguez-Lorenzo D, Altabás-González I, Pérez-Gómez N, Guzmán-Castro JH, Varela-Gestoso R, Díaz-Lambarri R, González-Carreró-López A, Míguez-Senra O, Bóveda-Fontán J, Charle-Crespo Á, Caramés-Casal FJ, Barbazán-Álvarez C, Hernández-Rodríguez Í, Maceiras-Pan F, Rodríguez-López M, Melero-González R, Rodríguez-Fernández JB. Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology. BMC Health Serv Res 2022; 22:60. [PMID: 35022061 PMCID: PMC8754366 DOI: 10.1186/s12913-021-07455-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe in detail an innovative program based on telemedicine for semi-automated prioritization of referrals from Primary Care (PC) to Rheumatology, for reproducibility purposes, and to present the results of the implementation study. METHODS The context and situation were carefully analyzed, paying attention to all processes in place, referral numbers, waiting times, and number of complementary tests prior to discharge from Rheumatology. The composition of the team, aims, users, scope, and implementation phases were defined. Eight process indicators were established and measured before and 32 months after the program implementation. RESULTS The program, which includes IT circuits, algorithms based on response to specific guideline-based checklists, e-consultation, and appointments based on priority, was fully implemented in our health area after a pilot study in two PC centers. After implementation, 6185 rheumatology referrals showed an e-consultation response delay of 8.95 days, and to first face-to-face visit (after e-consultation) of 12.6 (previous delay before program implementation was 83.1 days). Resolution by e-consultation reached 20% (1195 patients did not need seeing the rheumatologist to have the problem solved), and 1369 patients (32%) were discharged after the first visit. The overall resolution rate was 44.0% (2564 discharges/5830 e-consultations). From a random sample of 100 visits, only 10% of patients needed additional complementary tests to make a diagnosis and decision by Rheumatology (20.9% decrease from previous period). CONCLUSION A careful analysis of the situation and processes, with implementation of simple IT circuits, allows for the improvement of the efficiency and resolution of problems in Rheumatology.
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Affiliation(s)
- José María Pego-Reigosa
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Carlos Peña-Gil
- Cardiology Department, Santiago de Compostela Health Area, Santiago de Compostela, Spain
- Service of Research, Education, and Innovation, Galician Health Service, Santiago de Compostela, Spain
| | | | - Irene Altabás-González
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Naír Pérez-Gómez
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - John Henry Guzmán-Castro
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | | | | | | | | | | | | | | | - Ceferino Barbazán-Álvarez
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Íñigo Hernández-Rodríguez
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Francisco Maceiras-Pan
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Marina Rodríguez-López
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Rafael Melero-González
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
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Balsa A, García de Yébenes MJ, Carmona L. Multilevel factors predict medication adherence in rheumatoid arthritis: a 6-month cohort study. Ann Rheum Dis 2021; 81:327-334. [PMID: 34844924 DOI: 10.1136/annrheumdis-2021-221163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/03/2021] [Indexed: 01/20/2023]
Abstract
Non-adherence challenges efficacy and costs of healthcare. Knowledge of the underlying factors is essential to design effective intervention strategies. OBJECTIVES To estimate the prevalence of treatment adherence in rheumatoid arthritis (RA) and to evaluate its predictors. METHODS A 6-month prospective cohort study of patients with RA selected by systematic stratified sampling (33% on first disease-modifying rheumatic drug (DMARD), 33% on second-line DMARD and 33% on biologics). The outcome measure was treatment adherence, defined by a score greater than 80% both in the Compliance Questionnaire in Rheumatology and the Reported Adherence to Medication scale, and was estimated with 95% CIs. Predictive factors included sociodemographic, psychological, clinical, drug-related, patient-doctor relationship related and logistic. Their effect on 6-month adherence was examined by multilevel logistic models adjusted for baseline covariates. RESULTS 180 patients were recruited (77% women, mean age 60.8). The prevalence of adherence was 59.1% (95% CI 48.1% to 71.8%). Patients on biologics showed higher adherence and perceived a higher medication need than the others; patients on second-line DMARDs had experienced more adverse events than the others. The variables explaining adherence in the final multivariate model were the type of treatment prescribed (second-line DMARDs OR=5.22, and biologics OR=3.76), agreement on treatment (OR=4.57), having received information on treatment adaptation (OR=1.42) and the physician perception of patient trust (OR=1.58). These effects were independent of disease activity. CONCLUSION Treatment adherence in RA is far from complete. Psychological, communicational and logistic factors influence treatment adherence in RA to a greater extent than sociodemographic or clinical factors.
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Romera Baures M, Seoane-Mato D, Alegre-Sancho JJ, León L, Caracuel Ruiz MA, Calvo-Alen J, Stoye C, Fernández B, Núñez-Monje V, Freites-Núñez D, Ortega Castro R. Impact of rheumatoid arthritis on sexuality: adaptation and validation of the Qualisex questionnaire for use in Spain. Rheumatol Int 2021; 42:1819-1829. [PMID: 34783890 DOI: 10.1007/s00296-021-05043-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
Patients with rheumatoid arthritis (RA) have a significantly increased risk of sexual dysfunction. However, it is not properly included in commonly used questionnaires to assess health-related quality of life in RA. Qualisex is a questionnaire developed in France to assess the impact of RA on patients´ sexual function. Our aim was to adapt and validate this questionnaire for use with Spanish RA patients. Two independent translations and a backward translation were obtained. The final version was tested in a pilot study with 10 RA patients to detect any aspects that could hinder interpretation. The validity and reliability of the linguistically validated questionnaire were studied in a multicenter cross-sectional study, with a longitudinal component for reliability estimation. 125 RA patients were included. The response process, discrimination, internal consistency, internal structure, convergent validity (correlation with MGH-SFQ questionnaire, DAS-28, physician global assessment, patient global health assessment, RAID, HAQ, HADS and SF-12©) and reliability were analyzed. The inclusion of two extra items was proposed in the pilot study. The validity analysis detected responses for item 10 that were not coherent with responses for the rest of items. The Cronbach alpha coefficient was 0.971. The highest correlation (0.665) was obtained with MGH-SFQ (questionnaire measuring sexual functioning), followed by RAID (0.516). The intra-class correlation was 0.880 (95% CI 0.815; 0.923), higher than 0.85, which indicates excellent reliability. All parameters used to assess this questionnaire show highly acceptable values. Qualisex allows for a global score of RA patients' sexual functioning and can be self-administered.
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Affiliation(s)
- Montserrat Romera Baures
- Rheumatology Service, Hospital Universitari de Bellvitge, Barcelona, Spain. .,Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, C/ Josep Trueta, 08195, Sant Cugat del Vallès, Barcelona, Spain.
| | | | | | - Leticia León
- Rheumatology Department and IDISSC, Hospital Clínico San Carlos, Madrid, Spain.,Health Sciences, Universidad Camilo José Cela, Madrid, Spain
| | | | - Jaime Calvo-Alen
- Rheumatology Service, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
| | - Claudia Stoye
- Rheumatology Service, Hospital Universitario Araba, Vitoria-Gasteiz, Spain
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6
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Castañeda S, González C, Villaverde V, Lajas Petisco C, Castro MC, Jirout F, Obaya JC, Hermosa JC, Suárez C, García S, Rodero M, León L, López Esteban A, Gobbo M, Alcaide L, Torre-Alonso JC. Development and feasibility of 4 checklists for the evaluation of comorbidity in patients with rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis: GECOAI Project. REUMATOLOGIA CLINICA 2020; 18:S1699-258X(20)30225-4. [PMID: 33293243 DOI: 10.1016/j.reuma.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/28/2020] [Accepted: 09/03/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). METHODS A multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients' association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA. RESULTS Four comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice. CONCLUSIONS The use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice.
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Affiliation(s)
- Santos Castañeda
- Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-ROCHE, EPID-Futuro, Universidad Autónoma de Madrid (UAM), Madrid, España.
| | - Carlos González
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Virginia Villaverde
- Servicio de Reumatología, Hospital Universitario de Móstoles, Madrid, España
| | - Cristina Lajas Petisco
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, España
| | - María Carmen Castro
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, España
| | - Fernando Jirout
- Servicio de Reumatología, Hospital Monte Naranco, Oviedo, España
| | | | | | - Carmen Suárez
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, España
| | - Silvia García
- Servicio de Reumatología, Hospital Moises Broggi, Sant Joan Despí, Barcelona, España
| | - María Rodero
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, España
| | - Leticia León
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, España
| | - Amparo López Esteban
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Milena Gobbo
- Positivamente Centro de Psicología, Madrid, España
| | - Laly Alcaide
- Coordinadora Nacional de Artritis, Madrid, España
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7
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Alcaide L, Torralba AI, Eusamio Serre J, García Cotarelo C, Loza E, Sivera F. Current State, Control, Impact and Management of Rheumatoid Arthritis According to Patient: AR 2020 National Survey. REUMATOLOGIA CLINICA 2020; 18:S1699-258X(20)30243-6. [PMID: 33250361 DOI: 10.1016/j.reuma.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/28/2020] [Accepted: 10/15/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To analyse current status, control and impact of RA on patients' lives as well as the management of RA symptoms. METHODS A structured anonymous online questionnaire was designed and sent to patients with RA, aged 18 years or above living in Spain. Participants were invited though different strategies: 1) ConArtritis and related patients associations; 2) Patients participating in the platform www.in-pacient.es; 3) Links from ConArtritis website and open social networks. Sociodemographic and clinical variables, as well as others related to the objectives were collected. A descriptive analysis was performed. RESULTS We analysed 882 RA patients, 89% women, with a median age of 52 years, 31.9% disease duration <5 years. They reported a mean pain and patient global disease score (0-10) of 5.1 and 4.9 respectively. The rate of patients with many difficulties or inability to perform daily tasks varied from 6.4% to 49.2%. Based on the activity index 56.8% of patients reported high activity. We found a great or severe impact on the emotional well-being in 31.5% of patients, and of 29.2% in the workplace or academic setting. A total of 87.9% are taking some medication for RA, and 17.3% are little / not satisfied with them. In addition, 67.1% take conventional synthetic disease modifying drugs (DMARDs), and 45.9% biological therapies including biosimilars and small molecules. CONCLUSIONS The current impact of RA on patients' daily lives remains very high. A significant number of patients are not taking DMARDs (conventional synthetic and / or biologics) despite high activity.
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Affiliation(s)
- Laly Alcaide
- Coordinadora Nacional de Artritis, Madrid, España
| | | | | | | | | | - Francisca Sivera
- Servicio de Reumatología, Hospital General de Elda, Alicante, España.
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Launch and preliminary analysis of Hospital de La Princesa's inter-specialists biological therapies unit. ACTA ACUST UNITED AC 2019; 15:63-68. [PMID: 30691949 DOI: 10.1016/j.reuma.2018.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 11/24/2018] [Indexed: 11/23/2022]
Abstract
We herein describe an inter-specialists unit for the monitoring and management of biological therapies and analyze the utilization of biological agents across specialties and diseases. Protocols and therapeutic objectives, as well as outcomes and protocol deviations, are shared and discussed periodically between specialists. All patients treated at one centre with any biological treatment from January 2000 by rheumatology, gastroenterology, dermatology, or neurology, regardless diagnosis, are identified by Clinical Pharmacy and included in an ongoing database that detects use and outcome. The drugs, survival, and reasons for discontinuation differ significantly across specialties. This approach has helped us recognizing the challenges and size of the problem of sharing expensive medications across specialties, and has served as a starting point to contribute to the better use of these compounds.
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Variability in the prescription of biological drugs in rheumatoid arthritis in Spain: a multilevel analysis. Rheumatol Int 2018; 38:589-598. [DOI: 10.1007/s00296-018-3933-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/12/2018] [Indexed: 11/26/2022]
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10
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Horgan D, Schneider D, Pravettoni G, Paradiso A, Denis L, Chomienne C. Translational Education. Biomed Hub 2017; 2:72-78. [PMID: 31988937 PMCID: PMC6945921 DOI: 10.1159/000481127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/25/2017] [Indexed: 11/19/2022] Open
Abstract
The issue of translational education of healthcare professionals is a major one. It is clear that a great degree of upskilling is already required and, to keep pace with the science, this must be ongoing. Stakeholders need to achieve this together - with agreed-on standards across the board so that no patient is denied a suitable, virtually tailor-made treatment due to a lack of knowledge or understanding on behalf of the healthcare professional treating and diagnosing him or her. A key partner in tackling this is the healthcare community, and one way to achieve the goal is through increased EU-wide investment in translational education and training of healthcare professionals.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
| | | | - Gabriella Pravettoni
- Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | | | | | - Christine Chomienne
- Research and Innovation Department, National Cancer Institute, Paris, France
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11
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Lopez-Gonzalez R, Seoane-Mato D, Perez-Vicente S, Martin-Martinez MA, Sanchez-Alonso F, Silva-Fernandez L. Variability in the frequency of rheumatology consultations in patients with rheumatoid arthritis in Spain. Rheumatol Int 2016; 36:1525-1534. [PMID: 27538838 DOI: 10.1007/s00296-016-3547-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
The aim of this work was to assess the variability in the use of health-care resources, based on the number of visits to rheumatology departments by rheumatoid arthritis patients, in Spain, and its association with patient, physician and center characteristics. The sample consisted of patient records of men and women (aged 16 or older), with a clinical diagnosis of RA, who met the American Rheumatism Association 1987 revised criteria and who had been treated in a rheumatology department at a Spanish hospital with at least one visit to a rheumatologist during the two years preceding the date of the study. To analyze which variables were independently associated with the number of consultations, those with a statistically significant result in the bivariate analysis, or which were clinically relevant or deemed confounders, were used in the construction of a linear regression model. The records of 1188 RA patients were studied. The linear regression model explained the 26.67 % of the variability in the number of visits. The number of csDMARDs prescribed, the administration of biological therapy, corticoid prescription, the presence of nursing consultation, mean time to first visit in the department and attended population showed a positive significant association, while the presence of telephone consultation, distance from the hospital to the patient´s residence (≥20 km) and drug monitoring by rheumatology department + primary care physician or by other specialists were negatively associated with the number of consultations. We observed a high variability in the number of visits, which remains partially unexplained even after taking into account individual, physician and center characteristics.
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Affiliation(s)
- R Lopez-Gonzalez
- Rheumatology Unit, Rheumatology Department, Complejo Hospitalario de Zamora, Avenida Requejo 35, 49022, Zamora, Spain.
| | - D Seoane-Mato
- Research Unit, Spanish Society of Rheumatology, Madrid, Spain
| | - S Perez-Vicente
- Research Unit, Spanish Society of Rheumatology, Madrid, Spain
| | | | | | - L Silva-Fernandez
- Rheumatology Department, Complexo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, Spain
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Ferraz-Amaro I, Seoane-Mato D, Sánchez-Alonso F, Martín-Martínez MA. Synthetic disease-modifying antirheumatic drug prescribing variability in rheumatoid arthritis: a multilevel analysis of a cross-sectional national study. Rheumatol Int 2015; 35:1825-36. [DOI: 10.1007/s00296-015-3363-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/16/2015] [Indexed: 12/19/2022]
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13
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A European chart review study on early rheumatoid arthritis treatment patterns, clinical outcomes, and healthcare utilization. Rheumatol Int 2015; 35:1837-49. [DOI: 10.1007/s00296-015-3312-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/08/2015] [Indexed: 12/19/2022]
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Silva-Fernández L, Pérez-Vicente S, Martín-Martínez MA, López-González R. Variability in the prescription of non-biologic disease-modifying antirheumatic drugs for the treatment of spondyloarthritis in Spain. Semin Arthritis Rheum 2014; 44:633-40. [PMID: 25563529 DOI: 10.1016/j.semarthrit.2014.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 11/12/2014] [Accepted: 11/21/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To describe the variability in the prescription of non-biologic disease-modifying antirheumatic drugs (nbDMARDs) for the treatment of spondyloarthritis (SpA) in Spain and to explore which factors relating to the disease, patient, physician, and/or center contribute to these variations. METHODS A retrospective medical record review was performed using a probabilistic sample of 1168 patients with SpA from 45 centers distributed in 15/19 regions in Spain. The sociodemographic and clinical features and the use of drugs were recorded following a standardized protocol. Logistic regression, with nbDMARDs prescriptions as the dependent variable, was used for bivariable analysis. A multilevel logistic regression model was used to study variability. RESULTS The probability of receiving an nbDMARD was higher in female patients [OR = 1.548; 95% confidence interval (CI): 1.208-1.984], in those with elevated C-reactive protein (OR = 1.039; 95% CI: 1.012-1.066) and erythrocyte sedimentation rate (OR = 1.012; 95% CI: 1.003-1.021), in those with a higher number of affected peripheral joints (OR = 12.921; 95% CI: 2.911-57.347), and in patients with extra-articular manifestations like dactylitis (OR = 2.997; 95% CI: 1.868-4.809), psoriasis (OR = 2.601; 95% CI: 1.870-3.617), and enthesitis (OR = 1.717; 95% CI: 1.224-2.410). There was a marked variability in the prescription of nbDMARDs for SpA patients, depending on the center (14.3%; variance 0.549; standard error 0.161; median odds ratio 2.366; p < 0.001). After adjusting for patient and center variables, this variability fell to 3.8%. CONCLUSION A number of factors affecting variability in clinical practice, and which are independent of disease characteristics, are associated with the probability of SpA patients receiving nbDMARDs in Spain.
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Affiliation(s)
- Lucía Silva-Fernández
- Rheumatology Department, Complexo Hospitalario Universitario de Ferrol, Avenida da Residencia s/n, Ferrol, 15405, A Coruña, Spain.
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