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Trenaman L, Kaal KJ, Laba TL, Safari A, Aguiar M, Burch T, Beckett J, Munro S, Hudson M, Harrison M. The financial burden of accessing care for people with scleroderma in Canada: a patient-oriented, cross-sectional survey. CMAJ Open 2023; 11:E630-E636. [PMID: 37437955 PMCID: PMC10356003 DOI: 10.9778/cmajo.20220227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Patients with scleroderma require a lifetime of treatment and frequent contacts with rheumatologists and other health care professionals. Although publicly funded health care systems in Canada cover many costs, patients may still face a substantial financial burden in accessing care. The purpose of this study was to quantify out-of-pocket costs borne by people with scleroderma in Canada and compare this burden for those living in large communities and smaller communities. METHODS We analyzed responses to a Web-based survey of people living in Canada with scleroderma. Respondents reported annual out-of-pocket medical, travel and accommodation and other nonmedical costs (2019 Canadian dollars). We used descriptive statistics to describe travel distance and out-of-pocket costs. We used a 2-part model to estimate the impact on out-of-pocket costs of living in a large urban centre (≥ 100 000 population), compared with smaller urban centres or rural areas (< 100 000 population). We generated combined mean estimates from the 2-part models using predictive margins. RESULTS The survey included 120 people in Canada with scleroderma. The mean, annual, total out-of-pocket costs were $3357 (standard deviation $5580). Respondents living in smaller urban centres and rural areas reported higher mean total costs ($4148, 95% confidence interval [CI] $3618-$4680) and travel or accommodation costs ($1084, 95% CI $804-$1364) than those in larger urban centres (total costs $2678, 95% CI $2252-$3104; travel or accommodation costs $332, 95% CI $207-$458). INTERPRETATION Many patients with scleroderma incur considerable out-of-pocket costs, and this burden is exacerbated for those living in smaller urban centres and rural areas. Health care systems and providers should consider ways to alleviate this burden and support equitable access to care.
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Affiliation(s)
- Logan Trenaman
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - K Julia Kaal
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Tracey-Lea Laba
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Abdollah Safari
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Magda Aguiar
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Tiasha Burch
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Jennifer Beckett
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Sarah Munro
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Marie Hudson
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Mark Harrison
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
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Kwakkenbos L, Carrier ME, Welling J, Turner KA, Cumin J, Pépin M, van den Ende C, Schouffoer AA, Hudson M, van Breda W, Sauve M, Mayes MD, Malcarne VL, Nielson WR, Nguyen C, Boutron I, Rannou F, Thombs BD, Mouthon L. Randomized feasibility trial of the Scleroderma Patient-centered Intervention Network hand exercise program (SPIN-HAND). PeerJ 2022; 10:e13471. [PMID: 35945943 PMCID: PMC9357372 DOI: 10.7717/peerj.13471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 04/29/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose The Scleroderma Patient-centered Intervention Network (SPIN) online hand exercise program (SPIN-HAND), is an online self-help program of hand exercises designed to improve hand function for people with scleroderma. The objective of this feasibility trial was to evaluate aspects of feasibility for conducting a full-scale randomized controlled trial of the SPIN-HAND program. Materials and Methods The feasibility trial was embedded in the SPIN cohort and utilized the cohort multiple randomized controlled trial (cmRCT) design. In the cmRCT design, at the time of cohort enrollment, cohort participants consent to be assessed for trial eligibility and randomized prior to being informed about trials conducted using the cohort. When trials were conducted in the cohort, participants randomized to the intervention were informed and consented to access the intervention. Participants randomized to control were not informed that they have not received an intervention. All participants eligible and randomized to participate in the trial were included in analyses on an intent-to-treat basis. Cohort participants with a Cochin Hand Function Scale score ≥ 3/90 and an interest in using an online hand-exercise intervention were randomized (1:1 ratio) to be offered as usual care plus the SPIN-HAND Program or usual care for 3 months. User satisfaction was assessed with semi-structured interviews. Results Of the 40 randomized participants, 24 were allocated to SPIN-HAND and 16 to usual care. Of 24 participants randomized to be offered SPIN-HAND, 15 (63%) consented to use the program. Usage of SPIN-HAND content among the 15 participants who consented to use the program was low; only five (33%) logged in more than twice. Participants found the content relevant and easy to understand (satisfaction rating 8.5/10, N = 6). Automated eligibility and randomization procedures via the SPIN Cohort platform functioned properly. The required technical support was minimal. Conclusions Trial methodology functioned as designed, and the SPIN-HAND Program was feasibly delivered; however, the acceptance of the offer and use of program content among accepters were low. Adjustments to information provided to potential participants will be implemented in the full-scale SPIN-HAND trial to attempt to increase offer acceptance.
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Affiliation(s)
| | - Marie-Eve Carrier
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
| | - Joep Welling
- NVLE Dutch patient organization for systemic autoimmune diseases, Utrecht, The Netherlands
| | | | - Julie Cumin
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
| | - Mia Pépin
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada
| | | | - Anne A. Schouffoer
- Leiden University Medical Center, Leiden, The Netherlands,Haga Teaching Hospital, The Hague, The Netherlands
| | - Marie Hudson
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ward van Breda
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maureen Sauve
- Scleroderma Society of Ontario, Hamilton, Ontario, Canada,Scleroderma Canada, Ottawa, Ontario, Canada
| | - Maureen D. Mayes
- University of Texas McGovern School of Medicine, Houston, Texas, United States of America
| | | | | | | | - Isabelle Boutron
- Centre d’Épidémiologie Clinique, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Paris, France,Centre of Research Epidemiology and Statistics (CRESS), Inserm, INRA, Université de Paris, Paris, France
| | - François Rannou
- Université de Paris, Paris, France,Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Brett D. Thombs
- Lady Davis Institute of the Jewish General Hospital, Montreal, Canada,Department of Medicine, McGill University, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada,Department of Psychology, McGill University, Montreal, Quebec, Canada,Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d’Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France,APHP-CUP, Hôpital Cochin, Paris, France
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