1
|
Stradford L, Curtis JR, Zueger P, Xie F, Curtis D, Gavigan K, Clinton C, Venkatachalam S, Rivera E, Nowell WB. Wearable activity tracker study exploring rheumatoid arthritis patients' disease activity using patient-reported outcome measures, clinical measures, and biometric sensor data (the wear study). Contemp Clin Trials Commun 2024; 38:101272. [PMID: 38444876 PMCID: PMC10912436 DOI: 10.1016/j.conctc.2024.101272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 03/07/2024] Open
Abstract
Background Digital health studies using electronic patient reported outcomes (ePROs), wearables, and clinical data to provide a more comprehensive picture of patient health. Methods Newly initiated patients on upadacitinib or adalimumab for RA will be recruited from community settings in the Excellence NEtwork in RheumatoloGY (ENRGY) practice-based research network. Over the period of three to six months, three streams of data will be collected (1) linkable physician-derived data; (2) self-reported daily and weekly ePROs through the ArthritisPower registry app; and (3) biometric sensor data passively collected via wearable. These data will be analyzed to evaluate correlations among the three types of data and patient improvement on the newly initiated medication. Conclusions Results from this study will provide valuable information regarding the relationships between physician data, wearable data, and ePROs in patients newly initiating an RA treatment, and demonstrate the feasibility of digital data capture for Remote Patient Monitoring of patients with rheumatic disease.
Collapse
Affiliation(s)
| | - Jeffrey R. Curtis
- University of Alabama at Birmingham, Birmingham, AL, USA
- Illumination Health, Hoover, AL, USA
| | | | | | - David Curtis
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | - Cassie Clinton
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | |
Collapse
|
2
|
Goodman SM, Mannstadt I, Gibbons JAB, Rajan M, Bass A, Russell L, Mehta B, Figgie M, Parks ML, Venkatachalam S, Nowell WB, Brantner C, Lui G, Card A, Leung P, Tischler H, Young SR, Navarro-Millán I. Healthcare disparities: patients' perspectives on barriers to joint replacement. BMC Musculoskelet Disord 2023; 24:976. [PMID: 38110904 PMCID: PMC10726517 DOI: 10.1186/s12891-023-07096-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE Racial and ethnic disparities in arthroplasty utilization are evident, but the reasons are not known. We aimed to identify concerns that may contribute to barriers to arthroplasty from the patient's perspective. METHODS We identified patients' concerns about arthroplasty by performing a mixed methods study. Themes identified during semi-structured interviews with Black and Hispanic patients with advanced symptomatic hip or knee arthritis were used to develop a questionnaire to quantify and prioritize their concerns. Multiple linear and logistic regression analyses were conducted to determine the association between race/ethnicity and the importance of each theme. Models were adjusted for sex, insurance, education, HOOS, JR/KOOS, JR, and discussion of joint replacement with a doctor. RESULTS Interviews with eight participants reached saturation and provided five themes used to develop a survey answered by 738 (24%) participants; 75.5% White, 10.3% Black, 8.7% Hispanic, 3.9% Asian/Other. Responses were significantly different between groups (p < 0.05). Themes identified were "Trust in the surgeon" "Recovery", "Cost/Insurance", "Surgical outcome", and "Personal suitability/timing". Compared to Whites, Blacks were two-fold, Hispanics four-fold more likely to rate "Trust in the surgeon" as very/extremely important. Blacks were almost three times and Hispanics over six times more likely to rate "Recovery" as very/extremely important. CONCLUSION We identified factors of importance to patients that may contribute to barriers to arthroplasty, with marked differences between Blacks, Hispanics, and Whites.
Collapse
Affiliation(s)
- Susan M Goodman
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA.
- Department of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Insa Mannstadt
- Department of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - J Alex B Gibbons
- Department of Medicine, Columbia University Vagelos Physician of College and Surgeons, New York, NY, USA
| | - Mangala Rajan
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Anne Bass
- Department of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Linda Russell
- Department of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Bella Mehta
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
- Department of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Mark Figgie
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Michael L Parks
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | | | | | - Collin Brantner
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Geyanne Lui
- Department of Medicine, New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York, NY, USA
| | - Andrea Card
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Peggy Leung
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Henry Tischler
- Department of Orthopedic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Sarah R Young
- Department of Social Work, Binghamton University, Binghamton, NY, USA
| | - Iris Navarro-Millán
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
- Department of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| |
Collapse
|
3
|
Harrold LR, Zueger P, Nowell WB, Blachley T, Schrader A, Lakin PR, Curtis D, Stradford L, Venkatachalam S, Tundia N, Patel PA. A Real-World Effectiveness Study Using a Mobile Application to Evaluate Early Outcomes with Upadacitinib in Rheumatoid Arthritis. Rheumatol Ther 2023; 10:1519-1533. [PMID: 37728861 PMCID: PMC10654297 DOI: 10.1007/s40744-023-00594-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION The impact of upadacitinib on rheumatoid arthritis (RA) symptoms was evaluated during the first 12 weeks of treatment via patient-reported outcomes (PROs) using a mobile health application (app). METHODS Participating rheumatologists from the CorEvitas RA Registry (prospective, observational cohort) recruited patients with RA initiating upadacitinib treatment. A modified version of the ArthritisPower® app was used to collect PROs, including the Routine Assessment of Patient Index Data 3 (RAPID3), duration of morning joint stiffness, and the Patient-Reported Outcomes Measurement Information System (PROMIS)-Fatigue 7a Short Form at baseline and weeks 1-4, 8, and 12. RAPID3 responses over time were assessed using Kaplan-Meier estimation to determine the proportion of patients achieving disease activity improvement and minimal clinically important difference (MCID). Results were analyzed for all patients initiating upadacitinib and a subsample of TNF inhibitor (TNFi)-experienced patients with moderate to severe disease at baseline. RESULTS A total of 103 patients with RA initiating upadacitinib (62.1% TNFi-experienced) were included. At week 12, 53 patients (51.4%) completed the study and provided PRO data via the app. Among all patients, improvements in RAPID3, pain, morning stiffness, and fatigue were observed at week 1 and were maintained or further improved through week 12. At week 12, 37.5% of patients achieved RAPID3 low disease activity. Starting at week 1, improvements in RAPID3 disease activity category (19.4% of patients) and achievement of MCID (16.3%) were reported, with nearly 50% of patients achieving these outcomes by week 4 (RAPID3 category: 48.8%; MCID: 49.2%) and 60% by week 12 (RAPID3 category: 59.6%; MCID: 59.8%). TNFi-experienced patients generally reported similar outcomes. Patient-reported medication convenience and compliance were generally high. CONCLUSIONS In this real-world cohort of patients with RA, treatment with upadacitinib was associated with early and significant improvement in RAPID3, pain, morning stiffness, and fatigue regardless of prior TNFi experience. Clinically meaningful improvement in RAPID3 patient-reported disease activity was observed as early as week 1, with continued improvement reported through week 12.
Collapse
Affiliation(s)
- Leslie R Harrold
- CorEvitas, LLC, 300 5th Avenue, Waltham, MA, 02451, USA.
- University of Massachusetts Medical School, Worcester, MA, USA.
| | | | | | | | - Amy Schrader
- CorEvitas, LLC, 300 5th Avenue, Waltham, MA, 02451, USA
| | - Paul R Lakin
- CorEvitas, LLC, 300 5th Avenue, Waltham, MA, 02451, USA
| | - David Curtis
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | | | | | | | | |
Collapse
|
4
|
Venkatachalam S, Gavigan K, Banerjee S, Gordon J, Emrich L, Sullivan H, Blazer A, Banbury B, Weaver KN, Stradford L, Dronadula V, Degrassi A, Merkel PA, Shaw DG, Larsen K, Curtis JR, McBurney RN, Kappelman MD, George MD, Nowell WB. Engaging Multistakeholder Perspectives to Identify Patient-Centered Research Priorities Regarding Vaccine Uptake Among Adults With Autoimmune Conditions. ACR Open Rheumatol 2023; 5:290-297. [PMID: 37127530 PMCID: PMC10267803 DOI: 10.1002/acr2.11546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/12/2023] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE The study objective was to prioritize topics for future patient-centered research to increase uptake of common vaccines, such as for pneumococcal pneumonia, influenza, herpes zoster, human papillomavirus, and severe acute respiratory syndrome coronavirus 2, among adults living with autoimmune conditions. METHODS A steering committee (SC) was formed that included clinicians, patients, patient advocates, and researchers associated with rheumatic diseases (psoriatic arthritis, rheumatoid arthritis, vasculitis), inflammatory bowel disease, and multiple sclerosis. Through a scoping review and discussions, SC members identified research topics regarding vaccine uptake and/or hesitancy for prioritization. A larger multistakeholder alliance that included patients and patient advocates, clinicians, researchers, policy makers, regulators, and vaccine manufacturers conducted a modified Delphi exercise online with three rating rounds and one ranking round. Frequency analysis and comparisons across stakeholder groups were conducted. A weighted ranking score was generated for each item in the ranking round for final prioritization. RESULTS Through the Delphi process, 33 research topics were identified, of which 13 topics were rated as critical by more than 70% of all stakeholders (n = 31). The two highest ranked critical topics per the full stakeholder group were "How well a vaccine works for adults with autoimmune conditions" and "How beliefs about vaccine safety affect vaccine uptake." CONCLUSION A multistakeholder group identified key topics as critically important priorities for future research to decrease vaccine hesitancy and improve uptake of vaccines for adults with autoimmune conditions.
Collapse
Affiliation(s)
| | | | | | | | - Lisa Emrich
- Accelerated Cure ProjectWalthamMassachusetts
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Rapoport C, Wells C, Torres G, Ortiz-Maldonado R, Venkatachalam S, Stradford L, Gavigan K, Boyd-Floering B, Danila MI, Nowell WB, Carandang K. Balancing COVID-19 Risk With Physical and Mental Wellness: Perspectives of Patients With Autoimmune Rheumatic Diseases Throughout the Pandemic. ACR Open Rheumatol 2023. [PMID: 37170755 DOI: 10.1002/acr2.11551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE Patients with autoimmune rheumatic diseases (ARDs) are at greater risk of COVID-19 infection and hospitalization, increasing the stress and uncertainty already associated with unpredictable conditions. These may be heightened for patients with ARDs from underrepresented minority backgrounds. This study aimed to explore patient experiences and ARD-related challenges during the first year of the pandemic. METHODS Between December 2020 and May 2021, 60-minute semistructured interviews were conducted with English- and Spanish-speaking adults, aged 18 years or older with self-reported diagnosis of ARD, via phone or videoconferencing using an interview guide on living with an ARD during the pandemic. Analysis combined methods of phenomenology and content analysis through three steps: 1) summarizing interviews, 2) iteratively refining units of meaning, and 3) axial and selective coding to determine cross-cutting themes. Study procedures were conducted by a multidisciplinary team, a majority also diagnosed with ARDs. RESULTS The research team interviewed 22 patients (39.8 ± 15.7 years old; 82.8% female; 31.8% Hispanic or Latino/a/x) with ARDs. Themes included 1) information access and understanding, 2) problem solving access to health care, 3) balancing risks, and 4) mental health implications. Within these themes, patients from underrepresented minority backgrounds faced unique challenges. CONCLUSION Patients with ARDs require direct and timely communication about their risk of COVID-19 morbidity and mortality and require increased support for psychosocial and ARD-related implications of the pandemic. Health care systems must consider ways to support patients who are balancing chronic disease management with risk reduction for contracting emerging COVID-19 variants.
Collapse
Affiliation(s)
- Chelsea Rapoport
- San Diego State University and University of California San Diego Joint Doctoral Program, San Diego, California
| | - Courtney Wells
- University of Wisconsin-River Falls, River Falls, Wisconsin, USA
| | - Guadalupe Torres
- University of Wisconsin-River Falls, River Falls, Wisconsin, USA
| | | | | | | | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, New York
| | | | - Maria I Danila
- University of Alabama at Birmingham and Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
| | | | - Kristine Carandang
- Global Healthy Living Foundation, Upper Nyack, New York
- Young Patients' Autoimmune Research and Empowerment Alliance, University of Wisconsin-River Falls, River Falls, WI
| |
Collapse
|
6
|
Kasturi S, Price LL, LeClair A, Patel N, Shetty S, Sheira D, Weber S, Curtis D, Nowell WB, Salmon J, Terrin N, McAlindon TE, Mandl LA. Clinical integration of patient-reported outcome measures to enhance the care of patients with SLE: a multi-centre prospective cohort study. Rheumatology (Oxford) 2022; 61:4763-4774. [PMID: 35357445 PMCID: PMC9707322 DOI: 10.1093/rheumatology/keac200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/17/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To assess the feasibility and impact of integrating electronic patient-reported outcome measures (PROMs) into the routine outpatient care of patients with SLE. METHODS We conducted a prospective cohort study, utilizing a mixed-methods sequential explanatory design, of SLE outpatients receiving rheumatology care at two academic medical centres. Participants completed electronic PROMs at enrolment and then prior to their next two routine rheumatology visits. PROM score reports were shared with patients and rheumatologists before visits. Patients and rheumatologists completed post-visit surveys evaluating the utility of PROMs in the clinical encounters. Focus groups of patients and interviews with treating rheumatologists were conducted to further explore their experience utilizing PROMs. RESULTS A total of 105 SLE patients and 17 rheumatologists participated in the study. Patients completed PROMs in 159 of 184 encounters (86%), with 93% of surveys completed remotely. Patients reported that PROMs were 'quite a bit' or 'very' useful (55% of encounters) and beneficial to communication (55% of encounters). In contrast, physicians found PROMs useful (20%) and beneficial to communication (17%) less frequently. There was no significant change in visit length, health-related quality of life or disease activity after implementation of PROMs; however, patient satisfaction improved slightly. Qualitative analyses revealed that patients felt PROMs provided utility primarily by facilitating communication, particularly when physicians discussed the surveys. CONCLUSION The remote capture and integration of electronic PROMs into clinical care was feasible in a diverse cohort of SLE outpatients. PROMs were useful to patients and enhanced their clinical experience primarily by facilitating communication.
Collapse
Affiliation(s)
- Shanthini Kasturi
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University
- Institute for Clinical Research and Health Policy Studies
| | - Amy LeClair
- Department of Medicine, Tufts Medical Center, Boston, MA
| | - Neena Patel
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Shreya Shetty
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Dina Sheira
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
| | - Serena Weber
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | | | | | - Jane Salmon
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
- Division of Rheumatology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Norma Terrin
- Tufts Clinical and Translational Science Institute, Tufts University
| | | | - Lisa A Mandl
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
- Division of Rheumatology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
7
|
Ogdie A, Myers K, Mansfield C, Tillett W, Nash P, Leach C, Nowell WB, Gavigan K, Zueger P, McDearmon-Blondell E, Walsh J. Correction: Experiences and Treatment Preferences in Patients With Psoriatic Arthritis: A Cross-Sectional Study in the ArthritisPower Registry. Rheumatol Ther 2022; 9:1477-1480. [PMID: 36070073 PMCID: PMC9510072 DOI: 10.1007/s40744-022-00478-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelley Myers
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | - Carol Mansfield
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - William Tillett
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Peter Nash
- Department of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Colton Leach
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | | | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | | | | | - Jessica Walsh
- Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
8
|
Venkatachalam S, Nowell WB. Taking the Long View: Patients Perceive Benefits and Risks of Treatment as Multidimensional. J Rheumatol Suppl 2022; 49:971-973. [PMID: 35840147 DOI: 10.3899/jrheum.220637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As a chronic and systemic inflammatory condition, rheumatoid arthritis (RA) affects people's quality of life (QOL), with symptoms ranging from pain and fatigue to stiffness and restricted physical mobility. The availability of a number of longstanding and newer RA therapeutic options has helped combat troublesome aspects of the disease, including progressive joint erosion and damage.
Collapse
Affiliation(s)
- Shilpa Venkatachalam
- Shilpa Venkatachalam, xxx, W.B. Nowell, xxx, Global Healthy Living Foundation, Upper Nyack, New York, USA. The authors declare no conflicts of interest relevant to this article. Address correspondence to W.B. Nowell, Global Healthy Living Foundation, 515 N. Midland Ave., Upper Nyack, NY 10960, USA.
| | - W Benjamin Nowell
- Shilpa Venkatachalam, xxx, W.B. Nowell, xxx, Global Healthy Living Foundation, Upper Nyack, New York, USA. The authors declare no conflicts of interest relevant to this article. Address correspondence to W.B. Nowell, Global Healthy Living Foundation, 515 N. Midland Ave., Upper Nyack, NY 10960, USA.
| |
Collapse
|
9
|
Gavigan K, Nowell WB, Hunter T, Curtis JR, Malatestinic WN, Bolce RJ, Lisse JR, Walsh J. Employment, Work Productivity, and Biologic Treatments in Self-Reported Axial Spondyloarthritis: a Cross-Sectional Study in a Female Predominant Population from the ArthritisPower Registry. Rheumatol Ther 2022; 9:663-677. [PMID: 35191010 PMCID: PMC8964841 DOI: 10.1007/s40744-022-00428-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The aim of this study was to characterize employment, work productivity, and biologic disease-modifying anti-rheumatic drug (bDMARD) treatment in a predominantly female population of axial spondyloarthritis (axSpA) patients in a real-world setting. METHODS This was a cross-sectional study of axSpA participants within the ArthritisPower registry. Outcomes were assessed with surveys (Work Productivity and Activity Impairment [WPAI], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], and Patient-Reported Outcomes Measurement Information System instruments) and compared between subgroups (employed vs. not employed; taking vs. not taking a bDMARD). RESULTS Among the 195 participants, 117 (60.0%) were employed and 78 (40.0%) were not employed entirely or partially due to axSpA. The mean age of the participants was 47.6 years and 86.7% were female. Current bDMARD use was reported by 57.4% of those surveyed (59.8% employed vs. 53.9% not employed; p = 0.408). Compared to not employed participants, employed participants had more favorable disease activity (BASDAI 6.0 vs. 7.6; p < 0.001) and overall health (self-rated health 2.5 vs. 1.8; p < 0.001). Employed participants, compared to not employed participants, were diagnosed at an earlier age (36.0 vs. 42.5 years, respectively) and experienced a shorter time between symptom onset and diagnosis (9.5 vs. 13.6 years, respectively). Employed participants reported missing on average 6.5 days of work and experienced a 52.7% impairment on work productivity due to axSpA over a 3-month period. Absenteeism and presenteeism were statistically similar between participants taking a bDMARD versus those not taking a bDMARD. CONCLUSIONS Although bDMARD treatment rates were similar between employed and not employed participants, disease activity and overall health were better in employed than non-employed participants. Employed participants experienced substantial work productivity impairment due to axSpA.
Collapse
Affiliation(s)
- Kelly Gavigan
- Global Healthy Living Foundation, 515 N Midland Ave, Upper Nyack, NY, 10960, USA.
| | - W Benjamin Nowell
- Global Healthy Living Foundation, 515 N Midland Ave, Upper Nyack, NY, 10960, USA
| | | | | | | | | | | | | |
Collapse
|
10
|
Ogdie A, Myers K, Mansfield C, Tillett W, Nash P, Leach C, Nowell WB, Gavigan K, Zueger P, McDearmon-Blondell E, Walsh J. Experiences and Treatment Preferences in Patients With Psoriatic Arthritis: A Cross-Sectional Study in the ArthritisPower Registry. Rheumatol Ther 2022; 9:735-751. [PMID: 35279798 PMCID: PMC8964868 DOI: 10.1007/s40744-022-00436-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/25/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Despite recent advances in treatment for psoriatic arthritis (PsA), many patients experience inadequate response or intolerance to therapy, indicating that unmet treatment-related needs remain. To further characterize these unmet needs, we evaluated patients’ experiences regarding the burden of PsA symptoms and disease impacts, and patients’ preferences for treatment. Methods Patients from ArthritisPower, a rheumatology research registry, completed a web-based survey. Object case best–worst scaling (BWS) was used to evaluate the relative burden of 11 PsA-related symptoms and the relative importance of improvement in nine PsA-related disease impacts. BWS data were analyzed using a random-parameters logit model. Patient demographics, preferences for mode and frequency of therapy, and preferences for methotrexate were analyzed descriptively. Results Among the 332 participants, most were White (94%), female (80%), with mean age of 54 years (SD 11.4). In the BWS, joint pain was the most bothersome symptom, followed by other musculoskeletal pain and fatigue. The BWS for disease impacts found that improvements in the ability to perform physical activities were most important, followed by improvements in the ability to function independently, sleep quality, and the ability to perform daily activities. The most burdensome symptoms and desired disease impact improvements were similar in patients regardless of their experience with biologic disease-modifying antirheumatic drugs. The most preferred mode and frequency of treatment administration was oral, once-daily medication (preferred by 38% of respondents), and 74% prioritized therapies that significantly improved joint-related symptoms versus psoriasis-related symptoms. The majority of respondents (65%) preferred PsA treatment regimens that did not include methotrexate. Conclusions Patients with PsA from a rheumatology registry found musculoskeletal pain symptoms to be the most bothersome and prioritized improvements to functional impacts of their disease. These findings can better inform development of new therapies and guide shared patient-provider treatment decision-making. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-022-00436-x.
Collapse
Affiliation(s)
- Alexis Ogdie
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelley Myers
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | - Carol Mansfield
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - William Tillett
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Peter Nash
- Department of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Colton Leach
- RTI Health Solutions, 3040 East Cornwallis Road, Post Office Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | | | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | | | | | - Jessica Walsh
- Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
11
|
Danila MI, Gavigan K, Rivera E, Nowell WB, George MD, Curtis JR, Cristopher-Stine L, Banerjee S, Merkel PA, Young K, Shaw DG, Gordon J, Venkatachalam S. Patient Perceptions and Preferences Regarding Telemedicine for Rheumatologic Care during the COVID-19 Pandemic. Arthritis Care Res (Hoboken) 2022; 74:1049-1057. [PMID: 35040274 PMCID: PMC9011874 DOI: 10.1002/acr.24860] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 11/22/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022]
Abstract
Objective To assess the perceptions and preferences of telemedicine among patients with autoimmune rheumatic diseases during the COVID‐19 pandemic. Methods We conducted an online survey among patients with autoimmune rheumatic diseases. Attitudes about telemedicine (i.e., telemedicine acceptability), evaluated using the validated Telemedicine Perception Questionnaire (TMPQ), and visit satisfaction were assessed for different telemedicine experiences and types of autoimmune rheumatic disease. Results Of 3,369 invitations, 819 responses were received. Participants had a mean ± SD age of 58.6 ± 11.6 years and were mostly White (n = 759, or 92.7%) and female (n = 702, or 85.7%). Of the 618 participants who said that telemedicine was available to them, 449 (72.7%) reported having a telemedicine visit, with 303 (67.5%) reporting attending a telemedicine video visit. On a 0 to 10 scale, the mean ± SD visit satisfaction score was 7.3 ± 1.8, with 25.8% of respondents being very satisfied (scores of 9 or 10). Video visits and higher TMPQ scores were associated with higher satisfaction. Compared to those who did not experience a telemedicine visit, patients who did were more likely to prefer telemedicine (video or phone) for routine visits (73.7% versus 44.3%; P < 0.001), reviewing test results (64.8% versus 53.8%; P < 0.001), when considering changing medications (40.5% versus 26.8%; P < 0.001), and when starting a new injectable medication (18.9% versus 12.7%; P = 0.02). Conclusion During the COVID‐19 pandemic, patients with autoimmune rheumatic diseases frequently had telemedicine visits, with the majority held via video, and were satisfied with these visits. These results suggest that because patients prefer telemedicine for certain visit reasons, maximizing effective use of telemedicine will require personalized patient scheduling.
Collapse
|
12
|
Danila MI, Chen L, Ruderman EM, Owensby JK, O'Beirne R, Melnick JA, Harrold LR, Curtis D, Nowell WB, Curtis JR. Evaluation of an Intervention to Support Patient-Rheumatologist Conversations About Escalating Treatment in Patients with Rheumatoid Arthritis: A Proof-of-Principle Study. ACR Open Rheumatol 2021; 4:279-287. [PMID: 34962093 PMCID: PMC8992469 DOI: 10.1002/acr2.11393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 12/03/2022] Open
Abstract
Objective This study’s objective was to test whether an online video intervention discussing appropriate treatment escalation improves willingness to change treatment in people living with rheumatoid arthritis (RA). Methods We conducted a controlled, randomized trial among patients with RA enrolled in ArthritisPower, a United States patient registry. We recruited participants by email and surveyed their assessment of disease activity (patient global), satisfaction with disease control (patient acceptable symptom state), attitudes about RA medications, decisional conflict (decisional conflict scale), and willingness to modify RA treatment (choice predisposition scale, higher scores are better) if or when recommended by their rheumatologist. Intervention groups watched educational videos relevant to a treat‐to‐target (T2T) strategy, whereas control groups viewed vaccination‐related videos as an “attention control.” We compared the between‐group difference in patients’ willingness to modify RA treatment (primary outcome) and difference in decisional conflict about changing RA treatment (secondary outcome) after watching the videos using t tests. Results Participants with self‐reported RA (n = 208) were 90% White and 90% women, with a mean (standard deviation) age of 50 (11) years, and 52% reported familiarity with the RA T2T strategy. We found a significant improvement in between‐group difference in willingness to change RA treatment among intervention versus control participants (0.49 [95% confidence interval 0.09‐0.88], P = 0.02). The effect size (Glass’s delta) for the intervention was 0.48. Decisional conflict about treatment change decreased, but the between‐group difference was not significant. Conclusion This novel educational patient‐directed intervention discussing appropriate treatment escalation was associated with improved willingness to change RA treatment if or when recommended by a rheumatologist. Further studies should evaluate whether this change in patients’ predisposition translates into actual treatment escalation.
Collapse
Affiliation(s)
- Maria I Danila
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Lang Chen
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Ronan O'Beirne
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Leslie R Harrold
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - David Curtis
- Global Healthy Living Foundation, Upper Nyack, New York
| | | | | |
Collapse
|
13
|
Sylvia LG, Lunn MR, Obedin-Maliver J, McBurney RN, Nowell WB, Nosheny RL, Mularski RA, Long MD, Merkel PA, Pletcher MJ, Tovey RE, Scalchunes C, Sutphen R, Martin AS, Horn EJ, O'Boyle M, Pitch L, Seid M, Redline S, Greenebaum S, George N, French NJ, Faria CM, Puvanich N, Rabideau DJ, Selvaggi CA, Yu C, Faraone SV, Venkatachalam S, McCall D, Terry SF, Deckersbach T, Nierenberg AA. Online Mindfulness-Based Interventions for Well-Being: Randomized Comparative Effectiveness Trial (Preprint). J Med Internet Res 2021; 24:e35620. [PMID: 36094813 PMCID: PMC9513687 DOI: 10.2196/35620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mindfulness can improve overall well-being by training individuals to focus on the present moment without judging their thoughts. However, it is unknown how much mindfulness practice and training are necessary to improve well-being. Objective The primary aim of this study was to determine whether a standard 8-session web-based mindfulness-based cognitive therapy (MBCT) program, compared with a brief 3-session mindfulness intervention, improved overall participant well-being. In addition, we sought to explore whether the treatment effects differed based on the baseline characteristics of the participants (ie, moderators). Methods Participants were recruited from 17 patient-powered research networks, web-based communities of stakeholders interested in a common research area. Participants were randomized to either a standard 8-session MBCT or a brief 3-session mindfulness training intervention accessed on the web. The participants were followed for 12 weeks. The primary outcome of the study was well-being, as measured by the World Health Organization—Five Well-Being Index. We hypothesized that MBCT would be superior to a brief mindfulness training. Results We randomized 4411 participants, 3873 (87.80%) of whom were White and 3547 (80.41%) of female sex assigned at birth. The mean baseline World Health Organization—Five Well-Being Index score was 50.3 (SD 20.7). The average self-reported well-being in each group increased over the intervention period (baseline to 8 weeks; model-based slope for the MBCT group: 0.78, 95% CI 0.63-0.93, and brief mindfulness group: 0.76, 95% CI 0.60-0.91) as well as the full study period (ie, intervention plus follow-up; baseline to 20 weeks; model-based slope for MBCT group: 0.41, 95% CI 0.34-0.48; and brief mindfulness group: 0.33, 95% CI 0.26-0.40). Changes in self-reported well-being were not significantly different between MBCT and brief mindfulness during the intervention period (model-based difference in slopes: −0.02, 95% CI −0.24 to 0.19; P=.80) or during the intervention period plus 12-week follow-up (−0.08, 95% CI −0.18 to 0.02; P=.10). During the intervention period, younger participants (P=.05) and participants who completed a higher percentage of intervention sessions (P=.005) experienced greater improvements in well-being across both interventions, with effects that were stronger for participants in the MBCT condition. Attrition was high (ie, 2142/4411, 48.56%), which is an important limitation of this study. Conclusions Standard MBCT improved well-being but was not superior to a brief mindfulness intervention. This finding suggests that shorter mindfulness programs could yield important benefits across the general population of individuals with various medical conditions. Younger people and participants who completed more intervention sessions reported greater improvements in well-being, an effect that was more pronounced for participants in the MBCT condition. This finding suggests that standard MBCT may be a better choice for younger people as well as treatment-adherent individuals. Trial Registration ClinicalTrials.gov NCT03844321; https://clinicaltrials.gov/ct2/show/NCT03844321
Collapse
Affiliation(s)
- Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard University, Cambridge, MA, United States
| | - Mitchell R Lunn
- Stanford University School of Medicine, Stanford, CA, United States
| | | | - Robert N McBurney
- Accelerated Cure Project for Multiple Sclerosis, Waltham, MA, United States
| | | | - Rachel L Nosheny
- University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Richard A Mularski
- Kaiser Permanente Center for Health Research Northwest Region, Portland, OR, United States
| | - Millie D Long
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Peter A Merkel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Mark J Pletcher
- University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Roberta E Tovey
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Ann S Martin
- Parent Project Muscular Dystrophy, Washington, DC, United States
| | | | - Megan O'Boyle
- Phelan-McDermid Syndrome Foundation, Osprey, FL, United States
| | - Lisa Pitch
- ImproveCareNow Inc., Burlington, VT, United States
| | - Michael Seid
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Susan Redline
- Brigham and Women's Hospital, Boston, MA, United States
| | - Sophie Greenebaum
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Nevita George
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Noah J French
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Caylin M Faria
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Nicha Puvanich
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Dustin J Rabideau
- Biostatistics, Massachusetts General Hospital, Boston, MA, United States
| | - Caitlin A Selvaggi
- Biostatistics, Massachusetts General Hospital, Boston, MA, United States
| | - Chu Yu
- Biostatistics, Massachusetts General Hospital, Boston, MA, United States
| | - Stephen V Faraone
- State University of New York Upstate Medical University, Syracuse, NY, United States
| | | | - Debbe McCall
- Health eHeart Alliance, San Francisco, CA, United States
| | | | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard University, Cambridge, MA, United States
| |
Collapse
|
14
|
Salt E, Wiggins A, Lohr K, Crofford L, Studts J, Nowell WB, Cappelleri JC, Rayens MK. The development and validation of a Patient-Perceived Methotrexate Intolerance Scale for use in adult rheumatoid arthritis patients. Musculoskeletal Care 2021; 20:529-540. [PMID: 34878205 DOI: 10.1002/msc.1606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/OBJECTIVE To develop a scale to measure methotrexate intolerance for use in adult rheumatoid arthritis (RA) patients and to describe its psychometric properties. METHODS A three-phase study was conducted. During Phase 1, we conducted individual interviews with RA patients (n = 14) to inform our item development process. During Phase 2, we asked for RA patients' (n = 10) feedback on item readability, clarity and the scale's ability to measure methotrexate intolerance. During Phase 3, we had patients with RA (n = 204) complete the scale to develop a final version and to describe the scale's internal validity (Cronbach's alpha), test-retest reliability (intra-class correlation coefficients), construct validity and discriminant validity and the ability of the scale to discriminate between past and present methotrexate users. RESULTS The newly developed, weighted scale (Patient-Perceived Methotrexate Intolerance Scale [PPMIS]) includes four subscales: Methotrexate Benefits, Methotrexate Risks-Side Effect Considerations, RA Risks and Methotrexate Risks-Willingness to Take Methotrexate Despite Risks. Cronbach's alpha ranged from 0.79 to 0.94. Test-retest reliability at 2 weeks was 0.73-0.88. Construct validity was supported with significant logical relationships between subscale scores and the existing methotrexate intolerance scale and past/present methotrexate use. The PPMIS was able to correctly classify RA patients as a past versus present methotrexate user 77% of the time. At the cut point of 3.29, the sensitivity of the PPMIS is 74% and specificity is 72% to correctly classify patients into past/present methotrexate use. CONCLUSION This is the first known scale with favourable measurement properties to evaluate methotrexate intolerance using a patient-centred perspective.
Collapse
Affiliation(s)
- Elizabeth Salt
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Amanda Wiggins
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Kristine Lohr
- Department of Rheumatology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Leslie Crofford
- Division of Rheumatology & Immunology, Vanderbilt University, Nashville, Tennessee, USA
| | - Jamie Studts
- School of Medicine, Division of Medical Oncology, University of Colorado, Aurora, Colorado, USA
| | - W Benjamin Nowell
- Global Healthy Living Foundation and CreakyJoints, New York, New York, USA
| | | | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
15
|
George MD, Danila MI, Watrous D, Reddy S, Alper J, Xie F, Nowell WB, Kallich J, Clinton C, Saag KG, Curtis JR. Disruptions in Rheumatology Care and the Rise of Telehealth in Response to the COVID-19 Pandemic in a Community Practice-Based Network. Arthritis Care Res (Hoboken) 2021; 73:1153-1161. [PMID: 33973389 PMCID: PMC8212120 DOI: 10.1002/acr.24626] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/20/2021] [Indexed: 11/18/2022]
Abstract
Objective The effect of the COVID‐19 pandemic on community‐based rheumatology care and the use of telehealth is unclear. We undertook this study to investigate the impact of the pandemic on rheumatology care delivery in a large community practice–based network. Methods Using a community practice–based rheumatologist network, we examined trends in in‐person versus telehealth visits versus canceled visits in 3 time periods: pre–COVID‐19, COVID‐19 transition (6 weeks beginning March 23, 2020), and post–COVID‐19 transition (May‐August). In the transition period, we compared patients who received in‐person care versus telehealth visits versus those who cancelled all visits. We used multivariable logistic regression to identify factors associated with canceled or telehealth visits. Results Pre–COVID‐19, there were 7,075 visits/week among 60,002 unique rheumatology patients cared for by ~300 providers practicing in 92 offices. This number decreased substantially (24.6% reduction) during the COVID‐19 transition period for in‐person visits but rebounded to pre–COVID‐19 levels during the post–COVID‐19 transition. There were almost no telehealth visits pre–COVID‐19, but telehealth increased substantially during the COVID‐19 transition (41.4% of all follow‐up visits) and slightly decreased during the post–COVID‐19 transition (27.7% of visits). Older age, female sex, Black or Hispanic race/ethnicity, lower socioeconomic status, and rural residence were associated with a greater likelihood of canceling visits. Most factors were also associated with a lower likelihood of having telehealth versus in‐office visits. Patients living further from the rheumatologists’ office were more likely to use telehealth. Conclusion COVID‐19 led to large disruptions in rheumatology care; these disruptions were only partially offset by increases in telehealth use and disproportionately affected racial/ethnic minorities and patients with lower socioeconomic status. During the COVID‐19 era, telehealth continues to be an important part of rheumatology practice, but disparities in access to care exist for some vulnerable groups.
Collapse
Affiliation(s)
| | | | | | | | - Jeffrey Alper
- Medallion Clinical Research Institute, Naples, Florida
| | | | | | - Joel Kallich
- Massachusetts College of Pharmacy and Health Sciences University, Boston
| | | | | | | |
Collapse
|
16
|
Coetzee T, Ball MP, Boutin M, Bronson A, Dexter DT, English RA, Furlong P, Goodman AD, Grossman C, Hernandez AF, Hinners JE, Hudson L, Kennedy A, Marchisotto MJ, Matrisian L, Myers E, Nowell WB, Nosek BA, Sherer T, Shore C, Sim I, Smolensky L, Williams C, Wood J, Terry SF. Correction: Data Sharing Goals for Nonprofit Funders of Clinical Trials. J Particip Med 2021; 13:e31371. [PMID: 34255670 PMCID: PMC8280826 DOI: 10.2196/31371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timothy Coetzee
- National Multiple Sclerosis Society, Cherry Hill, NJ, United States
| | | | | | - Abby Bronson
- Edgewise Therapeutics, Boulder, CO, United States
| | | | - Rebecca A English
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, United States
| | | | - Andrew D Goodman
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | | | | | | | - Lynn Hudson
- Critical Path Institute, Tucson, AZ, United States
| | - Annie Kennedy
- Parent Project Muscular Dystrophy, Bethesda, MD, United States
| | | | - Lynn Matrisian
- Pancreatic Cancer Action Network, Washington, DC, United States
| | - Elizabeth Myers
- Doris Duke Charitable Foundation, New York, NY, United States
| | | | - Brian A Nosek
- Center for Open Science, Charlottesville, VA, United States
| | - Todd Sherer
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, United States
| | - Carolyn Shore
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, United States
| | - Ida Sim
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Luba Smolensky
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, United States
| | | | | | | |
Collapse
|
17
|
Birru Talabi M, Eudy AM, Jayasundara M, Haroun T, Nowell WB, Curtis JR, Crow-Hercher R, White W, Ginsberg S, Clowse MEB. Tough Choices: Exploring Medication Decision-Making During Pregnancy and Lactation Among Women With Inflammatory Arthritis. ACR Open Rheumatol 2021; 3:475-483. [PMID: 34114738 PMCID: PMC8281053 DOI: 10.1002/acr2.11240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/27/2021] [Indexed: 01/04/2023] Open
Abstract
Objective This study explored how women’s beliefs about drug safety and interactions with their health care providers influenced their decisions to continue arthritis medications during pregnancy and lactation. Methods We collaborated with ArthritisPower, a patient‐powered research network, and CreakyJoints, its partner online community, to develop and disseminate a survey among members with inflammatory arthritis who had at least one pregnancy after diagnosis. Participants’ free‐text responses were evaluated by using thematic analysis. Results Women in the sample were 40 years old on average (N = 66). Nineteen of their pregnancies had ended in fetal loss. Fifteen percent of all pregnancies were exposed to methotrexate. Among women who used safe arthritis medications, up to 80% discontinued treatment either in preparation for pregnancy or during pregnancy or lactation. Women’s decisions to continue medications during pregnancy were influenced by their perceptions of safety and advisement from health care providers, although they often described that advice about medication safety was inconsistent between providers. Conclusion Women often chose to endure active inflammatory arthritis rather than to use disease‐modifying antirheumatic drugs because of concerns about medication safety during pregnancy and lactation. Conflicting medical advice from health care providers undermined patients’ trust in their providers and in the safety of their medications. The high rate of peripartum exposure to methotrexate, a fetotoxic drug, underscores the need for better family planning care for women with childbearing potential.
Collapse
Affiliation(s)
| | - Amanda M Eudy
- Duke University Medical Center, Durham, North Carolina
| | | | | | - W Benjamin Nowell
- Global Healthy Living Foundation, CreakyJoints, Upper Nyack, New York
| | | | | | - Whitney White
- Global Healthy Living Foundation, CreakyJoints, Upper Nyack, New York
| | - Seth Ginsberg
- Global Healthy Living Foundation, CreakyJoints, Upper Nyack, New York
| | | |
Collapse
|
18
|
Giannouchos TV, Ferdinand AO, Ilangovan G, Ragan E, Nowell WB, Kum HC, Schmit CD. Identifying and prioritizing benefits and risks of using privacy-enhancing software through participatory design: a nominal group technique study with patients living with chronic conditions. J Am Med Inform Assoc 2021; 28:1746-1755. [PMID: 34010404 DOI: 10.1093/jamia/ocab073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE While patients often contribute data for research, they want researchers to protect their data. As part of a participatory design of privacy-enhancing software, this study explored patients' perceptions of privacy protection in research using their healthcare data. MATERIALS AND METHODS We conducted 4 focus groups with 27 patients on privacy-enhancing software using the nominal group technique. We provided participants with an open source software prototype to demonstrate privacy-enhancing features and elicit privacy concerns. Participants generated ideas on benefits, risks, and needed additional information. Following a thematic analysis of the results, we deployed an online questionnaire to identify consensus across all 4 groups. Participants were asked to rank-order benefits and risks. Themes around "needed additional information" were rated by perceived importance on a 5-point Likert scale. RESULTS Participants considered "allowance for minimum disclosure" and "comprehensive privacy protection that is not currently available" as the most important benefits when using the privacy-enhancing prototype software. The most concerning perceived risks were "additional checks needed beyond the software to ensure privacy protection" and the "potential of misuse by authorized users." Participants indicated a desire for additional information with 6 of the 11 themes receiving a median participant rating of "very necessary" and rated "information on the data custodian" as "essential." CONCLUSIONS Patients recognize not only the benefits of privacy-enhancing software, but also inherent risks. Patients desire information about how their data are used and protected. Effective patient engagement, communication, and transparency in research may improve patients' comfort levels, alleviate patients' concerns, and thus promote ethical research.
Collapse
Affiliation(s)
- Theodoros V Giannouchos
- Population Informatics Lab, School of Public Health, Texas A&M University, College Station, Texas, USA.,Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Alva O Ferdinand
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas, USA.,Southwest Rural Health Research Center, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Gurudev Ilangovan
- Population Informatics Lab, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Eric Ragan
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, Florida, USA
| | - W Benjamin Nowell
- Patient-Centered Research, Global Healthy Living Foundation, Upper Nyack, New York, USA
| | - Hye-Chung Kum
- Population Informatics Lab, School of Public Health, Texas A&M University, College Station, Texas, USA.,Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Cason D Schmit
- Population Informatics Lab, School of Public Health, Texas A&M University, College Station, Texas, USA.,Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas, USA
| |
Collapse
|
19
|
Nowell WB, Merkel PA, McBurney RN, Young K, Venkatachalam S, Shaw DG, Dobes A, Cerciello E, Kolaczkowski L, Curtis JR, Kappelman MD. Patient-Powered Research Networks of the Autoimmune Research Collaborative: Rationale, Capacity, and Future Directions. Patient 2021; 14:699-710. [PMID: 33904145 PMCID: PMC8075709 DOI: 10.1007/s40271-021-00515-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 12/18/2022]
Abstract
Patient-Powered Research Networks (PPRNs) are US-based registry infrastructures co-created by advocacy groups, patient research partners, academic investigators, and other healthcare stakeholders. Patient-Powered Research Networks collect information directly from patients to conduct and disseminate the results of patient-centered/powered research that helps patients make more informed decisions about their healthcare. Patient-Powered Research Networks gather and utilize real-world data and patient-reported outcomes to conduct comparative effectiveness, safety, and other research, and leverage the Internet to accomplish this effectively and efficiently. Four PPRNs focused on autoimmune and immune-mediated conditions formed the Autoimmune Research Collaborative: ArthritisPower (rheumatoid arthritis, spondyloarthritis, and other rheumatic and musculoskeletal diseases), IBD Partners (inflammatory bowel disease), iConquerMS (multiple sclerosis), and the Vasculitis PPRN (vasculitis). The Autoimmune Research Collaborative aims to inform the healthcare decision making of patients, care partners, and other stakeholders, such as clinicians, regulators, and payers. Illustrated by practical applications from the Autoimmune Research Collaborative and its constituent PPRNs, this article discusses the shared capacities and challenges of the PPRN model, and the opportunities presented by collaborating across autoimmune conditions to design, conduct, and disseminate patient-centered outcomes research.
Collapse
Affiliation(s)
- W Benjamin Nowell
- Global Healthy Living Foundation, 515 N. Midland Ave, Upper Nyack, NY, 10960, USA.
| | | | | | | | - Shilpa Venkatachalam
- Global Healthy Living Foundation, 515 N. Midland Ave, Upper Nyack, NY, 10960, USA
| | | | | | | | | | | | | |
Collapse
|
20
|
Coetzee T, Ball MP, Boutin M, Bronson A, Dexter DT, English RA, Furlong P, Goodman AD, Grossman C, Hernandez AF, Hinners JE, Hudson L, Kennedy A, Marchisotto MJ, Myers E, Nowell WB, Nosek BA, Sherer T, Shore C, Sim I, Smolensky L, Williams C, Wood J, Terry SF, Matrisian L. Data Sharing Goals for Nonprofit Funders of Clinical Trials. J Particip Med 2021; 13:e23011. [PMID: 33779573 PMCID: PMC8088851 DOI: 10.2196/23011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 01/25/2023] Open
Abstract
Sharing clinical trial data can provide value to research participants and communities by accelerating the development of new knowledge and therapies as investigators merge data sets to conduct new analyses, reproduce published findings to raise standards for original research, and learn from the work of others to generate new research questions. Nonprofit funders, including disease advocacy and patient-focused organizations, play a pivotal role in the promotion and implementation of data sharing policies. Funders are uniquely positioned to promote and support a culture of data sharing by serving as trusted liaisons between potential research participants and investigators who wish to access these participants’ networks for clinical trial recruitment. In short, nonprofit funders can drive policies and influence research culture. The purpose of this paper is to detail a set of aspirational goals and forward thinking, collaborative data sharing solutions for nonprofit funders to fold into existing funding policies. The goals of this paper convey the complexity of the opportunities and challenges facing nonprofit funders and the appropriate prioritization of data sharing within their organizations and may serve as a starting point for a data sharing toolkit for nonprofit funders of clinical trials to provide the clarity of mission and mechanisms to enforce the data sharing practices their communities already expect are happening.
Collapse
Affiliation(s)
- Timothy Coetzee
- National Multiple Sclerosis Society, Cherry Hill, NJ, United States
| | | | | | - Abby Bronson
- Edgewise Therapeutics, Boulder, CO, United States
| | | | - Rebecca A English
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, United States
| | | | - Andrew D Goodman
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | | | | | | | - Lynn Hudson
- Critical Path Institute, Tucson, AZ, United States
| | - Annie Kennedy
- Parent Project Muscular Dystrophy, Bethesda, MD, United States
| | | | - Elizabeth Myers
- Doris Duke Charitable Foundation, New York, NY, United States
| | | | - Brian A Nosek
- Center for Open Science, Charlottesville, VA, United States
| | - Todd Sherer
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, United States
| | - Carolyn Shore
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, United States
| | - Ida Sim
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Luba Smolensky
- The Michael J Fox Foundation for Parkinson's Research, New York, NY, United States
| | | | | | | | - Lynn Matrisian
- Pancreatic Cancer Action Network, Washington, DC, United States
| |
Collapse
|
21
|
Nowell WB, Gavigan K, Kannowski CL, Cai Z, Hunter T, Venkatachalam S, Birt J, Workman J, Curtis JR. Which patient-reported outcomes do rheumatology patients find important to track digitally? A real-world longitudinal study in ArthritisPower. Arthritis Res Ther 2021; 23:53. [PMID: 33568191 PMCID: PMC7873115 DOI: 10.1186/s13075-021-02430-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/19/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) are increasingly used to track symptoms and to assess disease activity, quality of life, and treatment effectiveness. It is therefore important to understand which PROs patients with rheumatic and musculoskeletal disease consider most important to track for disease management. METHODS Adult US patients within the ArthritisPower registry with ankylosing spondylitis, fibromyalgia syndrome, osteoarthritis, osteoporosis, psoriatic arthritis, rheumatoid arthritis, and systemic lupus erythematosus were invited to select between 3 and 10 PRO symptom measures they felt were important to digitally track for their condition via the ArthritisPower app. Over the next 3 months, participants (pts) were given the option to continue tracking their previously selected measures or to remove/add measures at 3 subsequent monthly time points (month [m] 1, m2, m3). At m3, pts prioritized up to 5 measures. Measures were rank-ordered, summed, and weighted based on pts rating to produce a summary score for each PRO measure. RESULTS Among pts who completed initial selection of PRO assessments at baseline (N = 253), 140 pts confirmed or changed PRO selections across m1-3 within the specified monthly time window (28 days ± 7). PROs ranked as most important for tracking were PROMIS Fatigue, Physical Function, Pain Intensity, Pain Interference, Duration of Morning Joint Stiffness, and Sleep Disturbance. Patient's preferences regarding the importance of these PROs were stable over time. CONCLUSION The symptoms that rheumatology patients prioritized for longitudinal tracking using a smartphone app were fatigue, physical function, pain, and morning joint stiffness.
Collapse
Affiliation(s)
| | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | | | | | | | | | - Julie Birt
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | |
Collapse
|
22
|
Fraenkel L, Wei Z, Ramsey C, Wiedmeyer C, Michaud K, Neogi T, Nowell WB, Venkatachalam S, Broniatowski DA. OPEX: Development of a novel overall patient experience measure to facilitate interpretation of comparison effectiveness studies. PLoS One 2021; 16:e0245598. [PMID: 33513209 PMCID: PMC7846019 DOI: 10.1371/journal.pone.0245598] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES A measure that encompasses both benefits and harms at the individual patient level may facilitate comparisons between treatment options and improve shared decision-making. The objective of this study was to develop a patient reported measure to capture overall experience (including both benefits and harms) of treatment using rheumatoid arthritis (RA) as a case example. METHODS Hierarchies for treatment benefits are known. Therefore, we developed a hierarchy of adverse events (AEs) using a series of trajectory mapping and paired comparison surveys. We subsequently used these data to construct a paired comparison survey, asking patients to compare options including both a specified level of benefit and an AE. These data were used to generate a hierarchy of overall experience on treatment. RESULTS 782 participants completed a series of three surveys. The trajectory mapping procedure and a paired comparison survey led to the generation of a hierarchy of AEs with nine levels ranging from No AEs to irreversible serious complications. In a third survey, in which AEs were paired with benefits, participants' ratings generated a 6-level hierarchy of overall experiences ranging from Major improvement + No, mild or manageable AEs (Level 1) to No improvement + Irreversible AEs (Level 6). CONCLUSIONS Using a trajectory mapping approach, we developed a patient reported measure representing the distribution of patients' overall experiences on treatment. The intent of this measure is to enable patients and their physicians to compare the percentage of patients experiencing each level of outcome, from most to least desirable, across treatments.
Collapse
Affiliation(s)
- Liana Fraenkel
- Department of Medicine, Section of Rheumatology, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Department of Medicine, Section of Rheumatology, Berkshire Health Systems, Pittsfield, Massachusetts, United States of America
| | - Zhenglin Wei
- Department of Engineering Management and Systems Engineering, The George Washington University, Washington, DC, United States of America
| | - Christine Ramsey
- Mental Illness Research Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States of America
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States of America
| | - Carole Wiedmeyer
- Patient-Centered Research, Global Heathy Living Foundation, Upper Nyack, NY, United States of America
| | - Kaleb Michaud
- Division of Rheumatology and Immunology, University of Nebraska Medical Center, Omaha, NE, United States of America
- Forward, The National Databank for Rheumatic Diseases, Wichita, KS, United States of America
| | - Tuhina Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, MA, United States of America
| | - W. Benjamin Nowell
- Patient-Centered Research, Global Heathy Living Foundation, Upper Nyack, NY, United States of America
| | - Shilpa Venkatachalam
- Patient-Centered Research, Global Heathy Living Foundation, Upper Nyack, NY, United States of America
| | - David A. Broniatowski
- Department of Engineering Management and Systems Engineering, The George Washington University, Washington, DC, United States of America
| |
Collapse
|
23
|
Agiro A, Chen X, Eshete B, Sutphen R, Bourquardez Clark E, Burroughs CM, Nowell WB, Curtis JR, Loud S, McBurney R, Merkel PA, Sreih AG, Young K, Haynes K. Data linkages between patient-powered research networks and health plans: a foundation for collaborative research. J Am Med Inform Assoc 2020; 26:594-602. [PMID: 30938759 DOI: 10.1093/jamia/ocz012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Patient-powered research networks (PPRNs) are a valuable source of patient-generated information. Diagnosis code-based algorithms developed by PPRNs can be used to query health plans' claims data to identify patients for research opportunities. Our objective was to implement privacy-preserving record linkage processes between PPRN members' and health plan enrollees' data, compare linked and nonlinked members, and measure disease-specific confirmation rates for specific health conditions. MATERIALS AND METHODS This descriptive study identified overlapping members from 4 PPRN registries and 14 health plans. Our methods for the anonymous linkage of overlapping members used secure Health Insurance Portability and Accountability Act-compliant, 1-way, cryptographic hash functions. Self-reported diagnoses by PPRN members were compared with claims-based computable phenotypes to calculate confirmation rates across varying durations of health plan coverage. RESULTS Data for 21 616 PPRN members were hashed. Of these, 4487 (21%) members were linked, regardless of any expected overlap with the health plans. Linked members were more likely to be female and younger than nonlinked members were. Irrespective of duration of enrollment, the confirmation rates for the breast or ovarian cancer, rheumatoid or psoriatic arthritis or psoriasis, multiple sclerosis, or vasculitis PPRNs were 72%, 50%, 75%, and 67%, increasing to 91%, 67%, 93%, and 80%, respectively, for members with ≥5 years of continuous health plan enrollment. CONCLUSIONS This study demonstrated that PPRN membership and health plan data can be successfully linked using privacy-preserving record linkage methodology, and used to confirm self-reported diagnosis. Identifying and confirming self-reported diagnosis of members can expedite patient selection for research opportunities, shorten study recruitment timelines, and optimize costs.
Collapse
Affiliation(s)
| | | | | | - Rebecca Sutphen
- Heath Informatics Institute, University of South Florida, Tampa, Florida, USA
| | | | | | | | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sara Loud
- Accelerated Cure Project, Waltham, Massachusetts, USA
| | | | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Antoine G Sreih
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kalen Young
- Vasculitis Foundation, Kansas City, Missouri, USA
| | | |
Collapse
|
24
|
Schmit C, Ajayi KV, Ferdinand AO, Giannouchos T, Ilangovan G, Nowell WB, Kum HC. Communicating With Patients About Software for Enhancing Privacy in Secondary Database Research Involving Record Linkage: Delphi Study. J Med Internet Res 2020; 22:e20783. [PMID: 33320097 PMCID: PMC7772068 DOI: 10.2196/20783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/24/2020] [Accepted: 10/26/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is substantial prior research on the perspectives of patients on the use of health information for research. Numerous communication barriers challenge transparency between researchers and data participants in secondary database research (eg, waiver of informed consent and knowledge gaps). Individual concerns and misconceptions challenge the trust in researchers among patients despite efforts to protect data. Technical software used to protect research data can further complicate the public's understanding of research. For example, MiNDFIRL (Minimum Necessary Disclosure For Interactive Record Linkage) is a prototype software that can be used to enhance the confidentiality of data sets by restricting disclosures of identifying information during the record linkage process. However, software, such as MiNDFIRL, which is used to protect data, must overcome the aforementioned communication barriers. One proposed solution is the creation of an interactive web-based frequently asked question (FAQ) template that can be adapted and used to communicate research issues to data subjects. OBJECTIVE This study aims to improve communication with patients and transparency about how complex software, such as MiNDFIRL, is used to enhance privacy in secondary database studies to maintain the public's trust in researchers. METHODS A Delphi technique with 3 rounds of the survey was used to develop the FAQ document to communicate privacy issues related to a generic secondary database study using the MiNDFIRL software. The Delphi panel consisted of 38 patients with chronic health conditions. We revised the FAQ between Delphi rounds and provided participants with a summary of the feedback. We adopted a conservative consensus threshold of less than 10% negative feedback per FAQ section. RESULTS We developed a consensus language for 21 of the 24 FAQ sections. Participant feedback demonstrated preference differences (eg, brevity vs comprehensiveness). We adapted the final FAQ into an interactive web-based format that 94% (31/33) of the participants found helpful or very helpful. The template FAQ and MiNDFIRL source code are available on GitHub. The results indicate the following patient communication considerations: patients have diverse and varied preferences; the tone is important but challenging; and patients want information on security, identifiers, and final disposition of information. CONCLUSIONS The findings of this study provide insights into what research-related information is useful to patients and how researchers can communicate such information. These findings align with the current understanding of health literacy and its challenges. Communication is essential to transparency and ethical data use, yet it is exceedingly challenging. Developing FAQ template language to accompany a complex software may enable researchers to provide greater transparency when informed consent is not possible.
Collapse
Affiliation(s)
- Cason Schmit
- Population Informatics Lab, Department of Health Policy & Management, Texas A&M University School of Public Health, College Station, TX, United States
| | - Kobi V Ajayi
- Population Informatics Lab, Department of Health Policy & Management, Texas A&M University School of Public Health, College Station, TX, United States
| | - Alva O Ferdinand
- Southwest Rural Health Research Center, Department of Health Policy & Management, Texas A&M University School of Public Health, College Station, TX, United States
| | - Theodoros Giannouchos
- Population Informatics Lab, Department of Health Policy & Management, Texas A&M University School of Public Health, College Station, TX, United States
- Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Gurudev Ilangovan
- Population Informatics Lab, Department of Health Policy & Management, Texas A&M University School of Public Health, College Station, TX, United States
| | | | - Hye-Chung Kum
- Population Informatics Lab, Department of Health Policy & Management, Texas A&M University School of Public Health, College Station, TX, United States
| |
Collapse
|
25
|
Banerjee S, George M, Young K, Venkatachalam S, Gordon J, Burroughs C, Curtis D, Ferrada M, Gavigan K, Grayson PC, Kullman J, Danila MI, Curtis JR, Shaw DG, Benjamin Nowell W, Merkel PA. Effects of the COVID-19 Pandemic on Patients Living With Vasculitis. ACR Open Rheumatol 2020; 3:17-24. [PMID: 33784021 PMCID: PMC7811691 DOI: 10.1002/acr2.11204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/23/2020] [Indexed: 01/10/2023] Open
Abstract
Objective This study aimed to analyze the concerns and health‐related behaviors in patients with vasculitis during the early phase of the coronavirus disease 2019 (COVID‐19) pandemic in North America. Methods Patients with vasculitis in North America were invited to complete an online survey through the Vasculitis Patient‐Powered Research Network in collaboration with the Vasculitis Foundation and the Relapsing Polychondritis Foundation. Questions focused on concerns and behaviors related to doctors’ visits, tests, medication, and telehealth use. Factors affecting their concern and health‐related behaviors were determined. Results Data from 662 patients were included: 90% of patients were White, 78% were women, 83% expressed moderate or high levels of concern about COVID‐19, and 87% reported that their vasculitis moderately or extremely affected their level of concern. Older age, female sex, lung disease, and immunosuppression were associated with greater concern. Doctors’ visits, laboratory tests, and other tests were avoided by 66%, 46%, and 40% of patients, respectively. Younger age, urban location, higher income, higher concern levels, and prednisone use (>10 mg/day) were associated with greater likelihood of avoiding visits or tests. Ten percent of patients on immunosuppressive therapy stopped their medication. Twenty‐nine percent patients on rituximab avoided an infusion. Forty‐four percent of patients had telehealth visits; more visits were reported for younger patients, for patients on glucocorticoids, and in Canada versus the United States. Conclusion During the COVID‐19 pandemic, patients with vasculitis have high levels of concern and exhibit potentially harmful health‐related behaviors. Health care use varies across different demographic groups and geographic regions. Specific strategies are warranted to facilitate engagement of these patients with the health care system during the pandemic.
Collapse
Affiliation(s)
| | | | - Kalen Young
- Vasculitis Foundation, Kansas City, Missouri, United States
| | | | - Jennifer Gordon
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | | | - David Curtis
- Global Healthy Living Foundation, New York, New York, United States
| | - Marcela Ferrada
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, United States
| | - Kelly Gavigan
- Global Healthy Living Foundation, New York, New York, United States
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, United States
| | - Joyce Kullman
- Vasculitis Foundation, Kansas City, Missouri, United States
| | | | | | - Dianne G Shaw
- Vasculitis Foundation, Kansas City, Missouri, United States
| | | | | | | |
Collapse
|
26
|
George MD, Venkatachalam S, Banerjee S, Baker JF, Merkel PA, Gavigan K, Curtis D, Danila MI, Curtis JR, Nowell WB. Concerns, Healthcare Use, and Treatment Interruptions in Patients With Common Autoimmune Rheumatic Diseases During the COVID-19 Pandemic. J Rheumatol 2020; 48:603-607. [PMID: 33191284 DOI: 10.3899/jrheum.201017] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess concerns and healthcare-related behaviors of patients with autoimmune rheumatic diseases during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Adults from the United States with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and systemic lupus erythematosus (SLE) from the ArthritisPower Patient-Powered Research Network and CreakyJoints patient community completed surveys. Concerns and behaviors were compared among patients with different autoimmune conditions, disease-modifying antirheumatic drug (DMARD) use, and geographic measures of urban status, income, education, and COVID-19 activity. RESULTS Among 1517 participants (925 RA, 299 PsA, 185 AS, 108 SLE), mean age was 55.1 years, 88.3% were female, and 89.5% were White. COVID-19 concerns were similar across the country and were higher in biologic users (P < 0.001). Avoidance of doctor's office visits (56.6%) or laboratory testing (42.3%) and use of telehealth (29.5%) were more common in urban areas. Among participants receiving a DMARD without COVID-19 or other respiratory illness, 14.9% stopped a DMARD, with 78.7% of DMARD interruptions not recommended by a physician. DMARD stopping was more common in participants with lower socioeconomic status (SES) and in participants who avoided an office visit (OR 1.46, 95% CI 1.04-2.04) or reported lack of telehealth availability OR 2.26 (95% CI 1.25-4.08). CONCLUSION In the early months of the COVID-19 pandemic, patients with RA, PsA, AS, and SLE frequently avoided office visits and laboratory testing. DMARD interruptions commonly occurred without the advice of a physician and were associated with SES, office visits, and telehealth availability, highlighting the need for adequate healthcare access and attention to vulnerable populations during the pandemic.
Collapse
Affiliation(s)
- Michael D George
- M.D. George, MD, MSCE, Assistant Professor, S. Banerjee, MD, Assistant Professor, J.F. Baker, MD, MSCE, Assistant Professor, P.A. Merkel, MD, MPH, Professor, University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Shilpa Venkatachalam
- S. Venkatachalam, PhD, MPH, K. Gavigan, MPH, D. Curtis, BA, W.B. Nowell, PhD, MSW, Global Healthy Living Foundation, Upper Nyack, New York
| | - Shubhasree Banerjee
- M.D. George, MD, MSCE, Assistant Professor, S. Banerjee, MD, Assistant Professor, J.F. Baker, MD, MSCE, Assistant Professor, P.A. Merkel, MD, MPH, Professor, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua F Baker
- M.D. George, MD, MSCE, Assistant Professor, S. Banerjee, MD, Assistant Professor, J.F. Baker, MD, MSCE, Assistant Professor, P.A. Merkel, MD, MPH, Professor, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter A Merkel
- M.D. George, MD, MSCE, Assistant Professor, S. Banerjee, MD, Assistant Professor, J.F. Baker, MD, MSCE, Assistant Professor, P.A. Merkel, MD, MPH, Professor, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kelly Gavigan
- S. Venkatachalam, PhD, MPH, K. Gavigan, MPH, D. Curtis, BA, W.B. Nowell, PhD, MSW, Global Healthy Living Foundation, Upper Nyack, New York
| | - David Curtis
- S. Venkatachalam, PhD, MPH, K. Gavigan, MPH, D. Curtis, BA, W.B. Nowell, PhD, MSW, Global Healthy Living Foundation, Upper Nyack, New York
| | - Maria I Danila
- M.I. Danila, MD, MSc, MSPH, Associate Professor, J.R. Curtis, MD, MS, MPH, Professor, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey R Curtis
- M.I. Danila, MD, MSc, MSPH, Associate Professor, J.R. Curtis, MD, MS, MPH, Professor, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - W Benjamin Nowell
- S. Venkatachalam, PhD, MPH, K. Gavigan, MPH, D. Curtis, BA, W.B. Nowell, PhD, MSW, Global Healthy Living Foundation, Upper Nyack, New York
| |
Collapse
|
27
|
Yun H, Nowell WB, Curtis D, H Willig J, Yang S, Auriemma M, Chen L, Filby C, Curtis JR. Assessing Rheumatoid Arthritis Disease Activity With Patient-Reported Outcomes Measurement Information System Measures Using Digital Technology. Arthritis Care Res (Hoboken) 2020; 72:553-560. [PMID: 30927515 DOI: 10.1002/acr.23888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 03/26/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Health information technology has enabled efficient measurement of patient-reported outcomes (PROs). The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) is becoming more widely adopted for research and routine care, and some PROMIS instruments might be substituted for lengthier, legacy PRO instruments. METHODS Four PROMIS computer-adaptive testing (CAT) instruments (pain interference, physical function, sleep disturbance, and fatigue) and the Routine Assessment of Patient Index Data 3 (RAPID3), along with pain intensity and patient global assessment score, were administered to participants in the ArthritisPower registry. The RAPID3 was predicted using different combinations of these variables to create a new score (CAT-PROMIS RAPID3). Kappa statistics and Bland-Altman 95% limits of agreement were used to measure agreement between the observed versus predicted RAPID3. RESULTS A total of 6,154 eligible patients contributed 11,275 observations. The mean ± SD age was 52.7 ± 10.5 years, and 93% of patients were women. The median assessment times ranged from 29 seconds (PROMIS sleep disturbance) to 116 seconds (RAPID3). As single pairwise comparisons, the PROMIS CATs examined were modestly correlated (r approximately 0.4-0.7) to one other and RAPID3. Together with the pain intensity and patient global assessment, the PROMIS instruments explained a high fraction of total variance (R2 = 0.97) of the RAPID3 score. In the model with the highest agreement (κ = 0.93) between the observed RAPID3 and the CAT-PROMIS predicted RAPID3, Bland-Altman 95% limits of agreement showed minimal residual differences and no systematic biases. CONCLUSION There was excellent agreement between the observed RAPID3 and predicted RAPID3 scores estimated using several PROMIS instruments. The Multidimensional Health Assessment Questionnaire and patient global assessment components of RAPID3 may be unnecessary if PROMIS scores are available.
Collapse
Affiliation(s)
| | | | - David Curtis
- Global Healthy Living Foundation, Upper Nyack, New York
| | | | | | | | | | | | | |
Collapse
|
28
|
Chen X, Agiro A, Nowell WB, Loud S, McBurney R, Young K, Sutphen R, Bourquardez Clark E, Burroughs CM, Curtis JR, Sreih AG, Merkel PA, Haynes K. Harnessing health plan enrollee data to boost membership in patient-powered research networks. BMC Health Serv Res 2020; 20:462. [PMID: 32450857 PMCID: PMC7249317 DOI: 10.1186/s12913-020-05325-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/14/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Patient-powered research networks (PPRNs) have been employing and exploring different methods to engage patients in research activities specific to their conditions. One way to intensify patient engagement is to partner with payer stakeholders. The objective of this study was to evaluate the effectiveness of two common payer-initiated outreach methods (postal mail versus email) for inviting prospective candidates to participate in their initiatives. METHODS This descriptive study linked members of a nationally-representative private insurance network to four disease-specific PPRN registries. Eligible members meeting diagnostic criteria who were not registered in any of the four PPRNs by 02/28/2018 were identified, and randomly assigned to either the mail or email group. They were contacted in two outreach efforts: first on 04/23/2018, and one follow-up on 05/23/2018. New registration rates by outreach method as of 8/31/2018 were determined by relinking. We compared registrants and non-registrants using bivariate analysis. RESULTS A total of 14,571 patients were assigned to the mail group, and 14,574 to the email group. Invitations were successfully delivered to 13,834 (94.9%) mail group and 10,205 (70.0%) email group members. A small but significantly larger proportion of mail group members, (n = 78; 0.54, 95% Confidence Interval [CI] {0.42-0.67%}) registered in PPRNs relative to the email group (n = 24; 0.16, 95% CI {0.11-0.25%}), p < 0.001. Members who registered had more comorbidities, were more likely to be female, and had marginally greater medical utilization, especially emergency room visits, relative to non-registrants (52.0% vs. 42.5%, p = 0.05). CONCLUSION A health plan outreach to invite members to participate in PPRNs was modestly effective. Regular mail outperformed less costly email. Providing more value-add to participants may be a possible way to increase recruitment success.
Collapse
Affiliation(s)
- Xiaoxue Chen
- HealthCore, Inc., 123 Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA.
| | - Abiy Agiro
- HealthCore, Inc., 123 Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA
| | | | - Sara Loud
- Accelerated Cure Project, Waltham, MA, USA
| | | | | | | | | | | | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Antoine G Sreih
- Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter A Merkel
- Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Haynes
- HealthCore, Inc., 123 Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA
| |
Collapse
|
29
|
Ogdie A, Nowell WB, Applegate E, Gavigan K, Venkatachalam S, de la Cruz M, Flood E, Schwartz EJ, Romero B, Hur P. Patient perspectives on the pathway to psoriatic arthritis diagnosis: results from a web-based survey of patients in the United States. BMC Rheumatol 2020; 4:2. [PMID: 31938764 PMCID: PMC6953285 DOI: 10.1186/s41927-019-0102-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/30/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There are limited real-world data on the diagnostic experiences of patients with psoriatic arthritis (PsA), including medical care sought and potential barriers to diagnosis. We aim to describe patient experiences related to receiving a PsA diagnosis. METHODS Ours was a mixed-method, 2-phase study. Phase 1 comprised concept elicitation and cognitive interviews with clinical experts and adults diagnosed with PsA to develop a cross sectional, web-based survey. US adults with a self-reported PsA diagnosis were recruited through a patient support community (CreakyJoints), an online patient research registry (ArthritisPower), and social media outreach. In Phase 2, the online survey collected data on sociodemographics, clinical symptoms, disease burden, and diagnosis history of survey respondents with PsA. RESULTS Of the 203 respondents included, 172 (84.7%) were female, and the mean (SD) age was 51.6 (10.8) years. The time between seeking medical attention and receiving a diagnosis was < 6 months for 69 respondents, 6 months to 4 years for 68 respondents, and ≥ 5 years for 66 respondents. Most respondents sought care from general practitioners (79.8%) and rheumatologists (66.5%). Common initial symptoms that led respondents to seek medical attention were joint pain (70.0%) and stiffness (53.7%). Among the initial symptoms that led respondents to seek care, joint pain, swollen joints, and sausage-like fingers or toes (indicating dactylitis) were more common among respondents with shorter time to diagnosis, whereas stiffness, fatigue, enthesitis (indicated by foot problems, tendon and ligament pain), and back pain were more common among respondents with longer time to diagnosis. Common misdiagnoses were psychosomatic issues (26.6%) and osteoarthritis (21.7%). Respondents with shorter times to diagnosis had lower frequencies of misdiagnosis. CONCLUSIONS Respondents with PsA reported delays in diagnosis and misdiagnoses on their journey to a PsA diagnosis. Symptom differences, such as enthesitis and stiffness, were noted among respondents with shorter vs longer time to diagnosis. Increased understanding of diagnostic barriers may lead to earlier diagnosis and appropriate management to improve outcomes.
Collapse
Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA 19104-4283 USA
| | | | | | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, NY USA
| | | | | | | | | | | | - Peter Hur
- Novartis Pharmaceuticals Corporation, East Hanover, NJ USA
| |
Collapse
|
30
|
Gavigan K, Nowell WB, Serna MS, Stark JL, Yassine M, Curtis JR. Barriers to treatment optimization and achievement of patients' goals: perspectives from people living with rheumatoid arthritis enrolled in the ArthritisPower registry. Arthritis Res Ther 2020; 22:4. [PMID: 31910893 PMCID: PMC6947932 DOI: 10.1186/s13075-019-2076-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated patients' own treatment goals in rheumatoid arthritis (RA). The objective of this real-world, cross-sectional study of US patients with RA was to identify factors that patients believed influenced their physician's treatment decisions. Secondary objectives included reasons patients tolerated sub-optimal disease control and their perceived barriers to treatment optimization. METHODS Eligible participants were enrolled in the ArthritisPower registry, ≥ 19 years, had physician-diagnosed RA, unchanged treatment within 3 months of baseline, prior/current disease-modifying antirheumatic drug treatment (DMARDs), and computer/smartphone access. In December 2017, participants completed Patient-Reported Outcomes Measurement Information System-Computerized Adaptive Tests (PROMIS-CAT) for pain interference, fatigue, sleep disturbance, and physical function. Routine Assessment of Patient Index Data 3 (RAPID3) provided disease activity scores (0-30). Participants completed an online survey on barriers to treatment optimization, including self-perception of disease compared to RAPID3/PROMIS scores. RESULTS A total of 249 participants met inclusion criteria and completed the survey. Mean age (SD) was 52 (11) years, and the majority were female (92%) with high RAPID3 disease activity (175/249 [70%]; median score 18). The main reason participants did not change treatment was their physician's recommendation (66%; n = 32). Of participants with high RAPID3 disease activity, 66 (38%) were offered a treatment change; 19 (29%) of whom declined the change. Most participants who intensified treatment did so because their symptoms had remained severe or worsened (51%; n = 65); only 16 (25%) participants intensified because they had not reached a specified treatment goal. Among participants who self-reported their disease activity as "none/low" or "medium" (n = 202; 81% of cohort), most still had RAPID3 high disease activity (137/202 [68%]; score > 12). Most PROMIS scores showed moderate agreement with participants' self-assessment of health status, in contrast to RAPID3 (weighted kappa: 0.05 [95% CI - 0.01, 0.11]). CONCLUSIONS Most participants trusted their rheumatologist's treatment decisions and prioritized their physician's treatment goals over their own. Patients should be encouraged to share their treatment goals/expectations with their rheumatologist, in line with the treat-to-target approach. RAPID3 may be inappropriate for setting patient-centric treatment goals given the poor agreement with self-reported disease activity; most PROMIS scores showed better alignment with patients' own assessments.
Collapse
Affiliation(s)
- Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, NY, USA.
| | | | | | | | | | | |
Collapse
|
31
|
Nowell WB. Information Patients Can Provide Will Strengthen the Real-World Evidence That Matters to Them. Clin Pharmacol Ther 2019; 106:49-51. [PMID: 31112287 DOI: 10.1002/cpt.1460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/01/2019] [Indexed: 11/06/2022]
|
32
|
Ogdie A, Benjamin Nowell W, Reynolds R, Gavigan K, Venkatachalam S, de la Cruz M, Flood E, Schwartz EJ, Romero B, Park Y. Real-World Patient Experience on the Path to Diagnosis of Ankylosing Spondylitis. Rheumatol Ther 2019; 6:255-267. [PMID: 31041666 PMCID: PMC6513959 DOI: 10.1007/s40744-019-0153-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction We describe the journey to diagnosis of ankylosing spondylitis (AS) from the patient perspective and examine differences in this journey by sex. Methods US adults aged ≥ 18 years with a self-reported AS diagnosis were recruited online through CreakyJoints, a patient support community, and ArthritisPower, a patient research registry. Respondents completed a web-based survey on sociodemographics, disease burden, and diagnosis history. Results were stratified by sex and time to diagnosis using two-sample t tests and χ2 tests, respectively, to observe differences across the groups; P < 0.05 was considered statistically significant. Results Among 235 respondents, 174 (74.0%) were female. Mean (SD) ages of female and male respondents were 48.6 (10.6) and 53.1 (10.3) years, respectively. From the time respondents began seeking medical attention, 87 were diagnosed within ≤ 1 year, 71 in 2–9 years, and 77 after ≥ 10 years. Symptoms that led respondents to seek treatment were back pain (73.2%) and joint pain (63.8%); fatigue and difficulty sleeping were more common among respondents with longer times to diagnosis. During the diagnosis process, men with AS tended to receive quicker AS diagnosis compared with women. Overall, commonly reported initial diagnoses among respondents with longer time to AS diagnosis included back problems and psychosomatic disorders. Significantly more women reported misdiagnoses of fibromyalgia (20.7 vs. 6.6%) and psychosomatic disorders (40.8 vs. 23.0%) compared with men. Conclusions Diagnosis delays and misdiagnoses were common among respondents with AS. Increasing awareness about AS among referring providers may minimize diagnosis delay. Funding Novartis Pharmaceuticals Corporation. Plain Language Summary Plain language summary available for this article. Electronic Supplementary Material The online version of this article (10.1007/s40744-019-0153-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | | | | | | | | | | | - Yujin Park
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| |
Collapse
|
33
|
Birru Talabi M, Eudy AM, Jayasundara M, Haroun T, Nowell WB, Curtis JR, Crow-Hercher R, White CW, Ginsberg S, Clowse MEB. Pregnancy, Periods, and "The Pill": Exploring the Reproductive Experiences of Women with Inflammatory Arthritis. ACR Open Rheumatol 2019; 1:125-132. [PMID: 31777789 PMCID: PMC6857994 DOI: 10.1002/acr2.1016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective Women with inflammatory arthritis appear to have fewer children as compared with healthy women, but few studies have assessed how patients' attitudes and decision making influence their family sizes. Little is also known about how patients experience other aspects of their reproductive lives, such as menstruation and contraception. Methods We partnered with ArthritisPower, a patient‐powered research network, and its associated online patient community, CreakyJoints, to create and disseminate a survey among female members aged 18‐50 years with inflammatory arthritis. Results Women in the final sample (n = 267) were 40 years old on average; most had rheumatoid arthritis (79%) and were predominantly white and college educated. Many women chose to limit childbearing because of their arthritis (58%); they feared that their arthritis was heritable, their diseases and medications could directly harm a fetus, they would be incapable of physically caring for a child, and arthritis could cause premature death, preventing them from raising their children. Infertility affected 40% of the sample. Half of women experienced subjective arthritis flares around the time of menstruation. Oral contraceptive pills (OCPs) did not worsen disease activity for most women and even prevented menstrual‐associated arthritis flares for a subset of women. Conclusion Our findings suggest that infertility, but also potentially outsized fear and anxiety related to their diagnoses, may affect the family sizes of women with inflammatory arthritis. The observation that menstruation worsens disease activity for some women requires additional study, and OCP use should be explored as a possible treatment for menstrual‐associated arthritis. Clinicians may wish to consider how they communicate patients' individual pregnancy‐associated risks, reassure patients when appropriate, and help to guide and support patients to make well‐informed reproductive decisions.
Collapse
Affiliation(s)
| | - Amanda M Eudy
- Duke University Medical Center Durham North Carolina
| | | | | | | | | | | | | | - Seth Ginsberg
- Global Healthy Living Foundation Upper Nyack New York
| | | |
Collapse
|
34
|
Hsiao B, Binder-Finnema P, Nowell WB, Michel G, Wiedmeyer C, Fraenkel L. Preference Phenotypes in Support of Shared Decision-Making at Point-of-Care for Patients With Rheumatoid Arthritis: A Proof-of-Concept Study. Arthritis Care Res (Hoboken) 2019; 71:629-637. [PMID: 29953733 DOI: 10.1002/acr.23684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/26/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE In this proof-of-concept study, we sought to evaluate whether a value clarification tool enabling patients to view a set of rheumatoid arthritis (RA) treatment preference phenotypes could be used to support shared decision-making at the point-of-care. METHODS We conducted a pretest/post test study. English-speaking patients with RA presenting to their scheduled outpatient visits were asked to participate. Visits for patients with active RA were transcribed. Shared decision-making components were measured using a quantitative coding scheme based on an established model of shared decision-making. RESULTS Forty-six visits were included in the pretest and 40 in the post test phases. Providers offered more disease-modifying antirheumatic drugs (DMARDs) (2 or more) in the post test visits (60%) compared to the pretest visits (47.8%). Overall, more patients vocalized their values and/or preferences in the post test visits compared to the pretest visits for treatment escalation decisions including a choice of 1 new DMARD (90.9% versus 56.3%), 2 or more new DMARDs (95.8% versus 86.4%), as well as prednisone (87.5% versus 66.7%). Providers were also more likely to base their recommendations on patients' values and/or preferences in the post test (100% of 6 visits) than the pretest (64.3% of 14 visits) phases during visits in which a recommendation was made. The mean ± SD length of the visit was 29.9 ± 11.6 minutes and 25.1 ± 10.7 minutes in the pretest and post test phases, respectively. CONCLUSION This study provides an early indication that a value clarification tool allowing patients to consider a set of preference phenotypes can support shared decision-making at the point-of-care without extending visit time.
Collapse
Affiliation(s)
- Betty Hsiao
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | - George Michel
- Yale University School of Medicine, New Haven, and Veterans Administration Connecticut Healthcare System, West Haven, Connecticut
| | | | - Liana Fraenkel
- Yale University School of Medicine, New Haven, and Veterans Administration Connecticut Healthcare System, West Haven, Connecticut
| |
Collapse
|
35
|
Li X, Fireman BH, Curtis JR, Arterburn DE, Fisher DP, Moyneur É, Gallagher M, Raebel MA, Nowell WB, Lagreid L, Toh S. Validity of Privacy-Protecting Analytical Methods That Use Only Aggregate-Level Information to Conduct Multivariable-Adjusted Analysis in Distributed Data Networks. Am J Epidemiol 2019; 188:709-723. [PMID: 30535131 PMCID: PMC6438804 DOI: 10.1093/aje/kwy265] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 12/11/2022] Open
Abstract
Distributed data networks enable large-scale epidemiologic studies, but protecting privacy while adequately adjusting for a large number of covariates continues to pose methodological challenges. Using 2 empirical examples within a 3-site distributed data network, we tested combinations of 3 aggregate-level data-sharing approaches (risk-set, summary-table, and effect-estimate), 4 confounding adjustment methods (matching, stratification, inverse probability weighting, and matching weighting), and 2 summary scores (propensity score and disease risk score) for binary and time-to-event outcomes. We assessed the performance of combinations of these data-sharing and adjustment methods by comparing their results with results from the corresponding pooled individual-level data analysis (reference analysis). For both types of outcomes, the method combinations examined yielded results identical or comparable to the reference results in most scenarios. Within each data-sharing approach, comparability between aggregate- and individual-level data analysis depended on adjustment method; for example, risk-set data-sharing with matched or stratified analysis of summary scores produced identical results, while weighted analysis showed some discrepancies. Across the adjustment methods examined, risk-set data-sharing generally performed better, while summary-table and effect-estimate data-sharing more often produced discrepancies in settings with rare outcomes and small sample sizes. Valid multivariable-adjusted analysis can be performed in distributed data networks without sharing of individual-level data.
Collapse
Affiliation(s)
- Xiaojuan Li
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Bruce H Fireman
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - David P Fisher
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California
| | | | - Mia Gallagher
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Marsha A Raebel
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - W Benjamin Nowell
- CreakyJoints, Global Healthy Living Foundation, Upper Nyack, New York
| | | | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| |
Collapse
|
36
|
Bingham Iii CO, Gutierrez AK, Butanis A, Bykerk VP, Curtis JR, Leong A, Lyddiatt A, Nowell WB, Orbai AM, Bartlett SJ. PROMIS Fatigue short forms are reliable and valid in adults with rheumatoid arthritis. J Patient Rep Outcomes 2019; 3:14. [PMID: 30790155 PMCID: PMC6384289 DOI: 10.1186/s41687-019-0105-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 02/12/2019] [Indexed: 12/30/2022] Open
Abstract
Background Fatigue is prevalent and impactful in rheumatoid arthritis (RA). There is no standardized measure for its assessment nor data concerning the performance of PROMIS-Fatigue short forms (SFs) in people with RA. We evaluated the construct validity of 4-, 7-, and 8-item PROMIS-Fatigue SFs in RA patients across the range of disease activity. Methods Adult RA patients were recruited from an online patient community and an observational cohort from three academic medical centers. Measures included PROMIS-Fatigue SFs, other PROMIS measures, and other patient reported outcomes including RAND-36 Vitality, Fatigue NRS, and patient global assessment of disease activity. Other measures from the observational cohort included 28-joint swollen and tender joints, physician global assessment, and the composite RA clinical disease activity index (CDAI). Results Two-hundred online participants and 348 participants from the observational cohort were included. PROMIS Fatigue SF scores spanned the measurement continuum and correlated highly with each other (r’s ≥ 0.91) and other fatigue measures (r’s ≥ 0.85). PROMIS-Fatigue SF scores were highly and inversely associated with Physical Function and Participation (r’s − 0.77 to − 0.78), and moderately-highly and positively correlated with pain, sleep disturbance, anxiety, and depression (r’s 0.60 to 0.75). PROMIS-Fatigue SF scores showed dose-response relationships across fatigue severity descriptors and CDAI categories. Conclusions These results provide robust evidence supporting the construct validity of the 4, 7, and 8-item PROMIS-Fatigue SFs. They capture fatigue across the spectrum of RA disease activity in diverse groups of individuals and should be considered for use as patient-centered assessments of disease control and treatment efficacy.
Collapse
Affiliation(s)
- Clifton O Bingham Iii
- Johns Hopkins Medicine, Division of Rheumatology, Mason F Lord Center Tower, 5200 Eastern Ave #434A, Baltimore, MD, 21224, USA.
| | - Anna Kristina Gutierrez
- Johns Hopkins Medicine, Division of Rheumatology, Mason F Lord Tower, 5200 Eastern Avenue, Rm 4100, Baltimore, MD, 21224, USA
| | - Alessandra Butanis
- Johns Hopkins Medicine, Division of Rheumatology, Mason F Lord Tower, 5200 Eastern Avenue, Rm 4100, Baltimore, MD, 21224, USA
| | - Vivian P Bykerk
- Hospital for Special Surgery, Weill Cornell Medical College, 525 East 71st St, 7th floor, New York, NY, 10021, USA
| | - Jeffrey R Curtis
- Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amye Leong
- Healthy Motivation, Santa Barbara, CA, USA
| | | | | | - Ana Maria Orbai
- Johns Hopkins Medicine, Division of Rheumatology, Mason F Lord Tower, 5200 Eastern Avenue, Rm 4100, Baltimore, MD, 21224, USA
| | - Susan J Bartlett
- Johns Hopkins Medicine, Division of Rheumatology, Mason F Lord Tower, 5200 Eastern Avenue, Rm 4100, Baltimore, MD, 21224, USA.,Center for Health Outcomes Research, McGill University, 5252 de Maisonneuve West, #3D-57, Montreal, QC, H4A 3S5, Canada
| |
Collapse
|
37
|
Singh JA, Guyatt G, Ogdie A, Gladman DD, Deal C, Deodhar A, Dubreuil M, Dunham J, Husni ME, Kenny S, Kwan-Morley J, Lin J, Marchetta P, Mease PJ, Merola JF, Miner J, Ritchlin CT, Siaton B, Smith BJ, Van Voorhees AS, Jonsson AH, Shah AA, Sullivan N, Turgunbaev M, Coates LC, Gottlieb A, Magrey M, Nowell WB, Orbai AM, Reddy SM, Scher JU, Siegel E, Siegel M, Walsh JA, Turner AS, Reston J. Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Rheumatol 2018; 71:5-32. [PMID: 30499246 DOI: 10.1002/art.40726] [Citation(s) in RCA: 267] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 09/11/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To develop an evidence-based guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). METHODS We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/comparator/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved consensus on the direction and the strength of the recommendations. RESULTS The guideline covers the management of active PsA in patients who are treatment-naive and those who continue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin-12/23 inhibitors (IL-12/23i), IL-17 inhibitors, CTLA4-Ig (abatacept), and a JAK inhibitor (tofacitinib). We also developed recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat-to-target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indicating the importance of active discussion between the health care provider and the patient to choose the optimal treatment. CONCLUSION The 2018 ACR/NPF PsA guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA.
Collapse
Affiliation(s)
- Jasvinder A Singh
- University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | | | | | - Dafna D Gladman
- University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | - Janice Lin
- Stanford University, Stanford, California
| | | | - Philip J Mease
- Swedish-Providence Health Systems and University of Washington, Seattle, Washington
| | - Joseph F Merola
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Julie Miner
- Comprehensive Therapy Consultants and Therapy Steps, Roswell, Georgia
| | | | | | - Benjamin J Smith
- Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee
| | | | - Anna Helena Jonsson
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Alice Gottlieb
- New York Medical College at Metropolitan Hospital, New York, New York
| | | | | | | | - Soumya M Reddy
- New York University School of Medicine, New York, New York
| | - Jose U Scher
- New York University School of Medicine, New York, New York
| | - Evan Siegel
- Arthritis & Rheumatism Associates, Rockville, Maryland
| | | | - Jessica A Walsh
- University of Utah and George E. Wahlen VeteranS Affairs Medical Center, Salt Lake City, Utah
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | | |
Collapse
|
38
|
Singh JA, Guyatt G, Ogdie A, Gladman DD, Deal C, Deodhar A, Dubreuil M, Dunham J, Husni ME, Kenny S, Kwan-Morley J, Lin J, Marchetta P, Mease PJ, Merola JF, Miner J, Ritchlin CT, Siaton B, Smith BJ, Van Voorhees AS, Jonsson AH, Shah AA, Sullivan N, Turgunbaev M, Coates LC, Gottlieb A, Magrey M, Nowell WB, Orbai AM, Reddy SM, Scher JU, Siegel E, Siegel M, Walsh JA, Turner AS, Reston J. 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2475530318812244] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: To develop an evidence-based guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). Methods: We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/comparator/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved consensus on the direction and the strength of the recommendations. Results: The guideline covers the management of active PsA in patients who are treatment-naive and those who continue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin-12/23 inhibitors (IL-12/23i), IL-17 inhibitors, CTLA4-Ig (abatacept), and a JAK inhibitor (tofacitinib). We also developed recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat-to-target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indicating the importance of active discussion between the health care provider and the patient to choose the optimal treatment. Conclusion: The 2018 ACR/NPF PsA guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA.
Collapse
Affiliation(s)
- Jasvinder A. Singh
- University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | | | - Alexis Ogdie
- University of Pennsylvania, Philadelphia, PA, USA
| | - Dafna D. Gladman
- University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Chad Deal
- Cleveland Clinic, Cleveland, OH, USA
| | - Atul Deodhar
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | | | | | | | | | | - Philip J. Mease
- Swedish-Providence Health Systems and University of Washington, Seattle, WA, USA
| | - Joseph F. Merola
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie Miner
- Comprehensive Therapy Consultants and Therapy Steps, Roswell, GA, USA
| | | | | | - Benjamin J. Smith
- Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee, FL, USA
| | | | | | | | | | | | | | - Alice Gottlieb
- New York Medical College at Metropolitan Hospital, New York, NY, USA
| | | | | | | | | | - Jose U. Scher
- New York University School of Medicine, New York, NY, USA
| | - Evan Siegel
- Arthritis & Rheumatism Associates, Rockville, MA, USA
| | | | - Jessica A. Walsh
- University of Utah and George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | | | | |
Collapse
|
39
|
Singh JA, Guyatt G, Ogdie A, Gladman DD, Deal C, Deodhar A, Dubreuil M, Dunham J, Husni ME, Kenny S, Kwan-Morley J, Lin J, Marchetta P, Mease PJ, Merola JF, Miner J, Ritchlin CT, Siaton B, Smith BJ, Van Voorhees AS, Jonsson AH, Shah AA, Sullivan N, Turgunbaev M, Coates LC, Gottlieb A, Magrey M, Nowell WB, Orbai AM, Reddy SM, Scher JU, Siegel E, Siegel M, Walsh JA, Turner AS, Reston J. Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2018; 71:2-29. [PMID: 30499259 DOI: 10.1002/acr.23789] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 09/11/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To develop an evidence-based guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). METHODS We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/comparator/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved consensus on the direction and the strength of the recommendations. RESULTS The guideline covers the management of active PsA in patients who are treatment-naive and those who continue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin-12/23 inhibitors (IL-12/23i), IL-17 inhibitors, CTLA4-Ig (abatacept), and a JAK inhibitor (tofacitinib). We also developed recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat-to-target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indicating the importance of active discussion between the health care provider and the patient to choose the optimal treatment. CONCLUSION The 2018 ACR/NPF PsA guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA.
Collapse
Affiliation(s)
- Jasvinder A Singh
- University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | | | | | - Dafna D Gladman
- University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | - Janice Lin
- Stanford University, Stanford, California
| | | | - Philip J Mease
- Swedish-Providence Health Systems and University of Washington, Seattle, Washington
| | - Joseph F Merola
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Julie Miner
- Comprehensive Therapy Consultants and Therapy Steps, Roswell, Georgia
| | | | | | - Benjamin J Smith
- Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee
| | | | - Anna Helena Jonsson
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Alice Gottlieb
- New York Medical College at Metropolitan Hospital, New York, New York
| | | | | | | | - Soumya M Reddy
- New York University School of Medicine, New York, New York
| | - Jose U Scher
- New York University School of Medicine, New York, New York
| | - Evan Siegel
- Arthritis & Rheumatism Associates, Rockville, Maryland
| | | | - Jessica A Walsh
- University of Utah and George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | | |
Collapse
|
40
|
Bartlett SJ, Gutierrez AK, Butanis A, Bykerk VP, Curtis JR, Ginsberg S, Leong AL, Lyddiatt A, Nowell WB, Orbai AM, Smith KC, Bingham CO. Combining online and in-person methods to evaluate the content validity of PROMIS fatigue short forms in rheumatoid arthritis. Qual Life Res 2018; 27:2443-2451. [PMID: 29797175 PMCID: PMC6113070 DOI: 10.1007/s11136-018-1880-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Fatigue is frequent and often severe and disabling in RA, and there is no consensus on how to measure it. We used online surveys and in-person interviews to evaluate PROMIS Fatigue 7a and 8a short forms (SFs) in people with RA. METHODS We recruited people with RA from an online patient community (n = 200) and three academic medical centers (n = 84) in the US. Participants completed both SFs then rated the comprehensiveness and comprehensibility of the items to their fatigue experience. Cognitive debriefing of items was conducted in a subset of 32 clinic patients. Descriptive statistics were calculated, and associations were evaluated using Pearson and Spearman correlation coefficients. RESULTS Mean SF scores were similar (p ≥ .61) among clinic patients reflecting mild fatigue (i.e., 54.5-55.9), but were significantly higher (p < .001) in online participants. SF Fatigue scores correlated highly (r ≥ 0.82; p < .000) and moderately with patient assessments of disease activity (r ≥ 0.62; p = .000). Most (70-92%) reported that the items "completely" or "mostly" reflected their experience. Almost all (≥ 94%) could distinguish general fatigue from RA fatigue. Most (≥ 85%) rated individual items questions as "somewhat" or "very relevant" to their fatigue experience, averaged their fatigue over the past 7 days (58%), and rated fatigue impact versus severity (72 vs. 19%). 99% rated fatigue as an important symptom they considered when deciding how well their current treatment was controlling their RA. CONCLUSIONS Results suggest that items in the single-score PROMIS Fatigue SFs demonstrate content validity and can adequately capture the wide range of fatigue experiences of people with RA.
Collapse
Affiliation(s)
- S J Bartlett
- Center for Health Outcomes Research, McGill University, 5252 de Maisonneuve West, #3D-57, Montreal, QC, H4A 3S5, Canada.
- Division of Rheumatology, Johns Hopkins School of Medicine, Mason F Lord Tower, 5200 Eastern Avenue, Rm 404, Baltimore, MD, 21224, USA.
| | - A K Gutierrez
- Division of Rheumatology, Johns Hopkins School of Medicine, Mason F Lord Tower, 5200 Eastern Avenue, Rm 404, Baltimore, MD, 21224, USA
- Ateneo School of Medicine and Public Health, Pasig City, Philippines
| | - A Butanis
- Division of Rheumatology, Johns Hopkins School of Medicine, Mason F Lord Tower, 5200 Eastern Avenue, Rm 404, Baltimore, MD, 21224, USA
| | - V P Bykerk
- Hospital for Special Surgery, Weill Cornell Medical College, 525 East 71st St, 7th floor, New York, NY, 10021, USA
| | - J R Curtis
- Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - S Ginsberg
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | - A L Leong
- Healthy Motivation, Santa Barbara, CA, USA
| | | | - W B Nowell
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | - A M Orbai
- Division of Rheumatology, Johns Hopkins School of Medicine, Mason F Lord Tower, 5200 Eastern Avenue, Rm 404, Baltimore, MD, 21224, USA
| | - K C Smith
- Johns Hopkins Bloomberg School of Public Health Center for Qualitative Studies in Health and Medicine, Baltimore, MD, USA
| | - C O Bingham
- Division of Rheumatology, Johns Hopkins School of Medicine, Mason F Lord Tower, 5200 Eastern Avenue, Rm 404, Baltimore, MD, 21224, USA
| |
Collapse
|
41
|
Fraenkel L, Benjamin Nowell W, Stake CE, Venkatachalam S, Eyler R, Michel G, Peters E. Impact of Information Presentation Format on Preference for Total Knee Replacement Surgery. Arthritis Care Res (Hoboken) 2018; 71:379-384. [PMID: 29799668 DOI: 10.1002/acr.23605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/22/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Patients have a poor understanding of outcomes related to total knee replacement (TKR) surgery, with most patients underestimating the potential benefits and overestimating the risk of complications. In this study, we sought to compare the impacts of descriptive information alone or in combination with an icon array, experience condition (images), or spinner on participants' preference for TKR. METHODS A total of 648 members of an online arthritis network were randomized to 1 of 4 outcome presentation formats: numeric only, numeric with an icon array, numeric with a set of 50 images, or numeric with a functional spinner. Preferences for TKR were measured before and immediately after viewing the outcome information using an 11-point numeric rating scale. Knowledge was assessed by asking participants to report the frequency of each outcome. RESULTS Participants randomized to the icon array, images, and spinner had stronger preferences for TKR (after controlling for baseline preferences) compared to those viewing the numeric only format (P < 0.05 for all mean differences). Knowledge scores were highest in participants randomized to the icon array; however, knowledge did not mediate the association between format and change in preference for TKR. CONCLUSION Decision support at the point-of-care is being increasingly recognized as a vital component of care. Our findings suggest that adding graphic information to descriptive statistics strengthens preferences for TKR. Although experience formats using images may be too complex to use in clinical practice, icon arrays and spinners may be a viable and easily adaptable decision aid to support communication of probabilistic information.
Collapse
Affiliation(s)
- Liana Fraenkel
- Yale University School of Medicine, New Haven, and Veterans Administration Connecticut Healthcare System, West Haven, Connecticut
| | - W Benjamin Nowell
- CreakyJoints, Global Healthy Living Foundation, Upper Nyack, New York
| | - Christine E Stake
- CreakyJoints, Global Healthy Living Foundation, Upper Nyack, New York
| | | | - Rachel Eyler
- University of Connecticut School of Pharmacy, Storrs
| | - George Michel
- Yale University School of Medicine, New Haven, Connecticut
| | | |
Collapse
|
42
|
Fraenkel L, Nowell WB, Michel G, Wiedmeyer C. Preference phenotypes to facilitate shared decision-making in rheumatoid arthritis. Ann Rheum Dis 2017; 77:678-683. [PMID: 29247126 DOI: 10.1136/annrheumdis-2017-212407] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Implementing treat-to-target (TTT) strategies requires that patients with rheumatoid arthritis (RA) and their rheumatologists decide on how best to escalate care when indicated. The objective of this study was to develop preference phenotypes to facilitate shared decision-making at the point of care for patients failing methotrexate monotherapy. METHODS We developed a conjoint analysis survey to measure the preferences of patient with RA for triple therapy, biologics and Janus kinase (JAK) inhibitors. The survey included seven attributes: administration, onset, bothersome side effects, serious infection, very rare side effects, amount of information and cost. Each choice set (n=12) included three hypothetical profiles. Preference phenotypes were identified by applying latent class analysis to the conjoint data. RESULTS 1273 participants completed the survey. A five-group solution was chosen based on progressively lower values of the Akaike and Bayesian information criteria. Members of the largest group (group 3: 38.4%) were most strongly impacted by the cost of the medication. The next largest group (group 1: 25.8%) was most strongly influenced by the risk of bothersome side effects. Members of group 2 (11.2%) were also risk averse, but were most concerned with the risk of very rare side effects. Group 4 (6.6%) strongly preferred oral over parenteral medications. Members of group 5 (18.0%) were most strongly and equally influenced by onset of action and the risk of serious infections. CONCLUSIONS Treatment preferences of patients with RA can be measured and represented by distinct phenotypes. Our results underscore the variability in patients' values and the importance of using a shared decision-making approach to implement TTT.
Collapse
Affiliation(s)
- Liana Fraenkel
- School of Medicine, Yale University, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - W Benjamin Nowell
- CreakyJoints, Global Healthy Living Foundation, New York City, New York, USA
| | - George Michel
- School of Medicine, Yale University, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Carole Wiedmeyer
- CreakyJoints, Global Healthy Living Foundation, New York City, New York, USA
| |
Collapse
|
43
|
Mazor KM, Richards A, Gallagher M, Arterburn DE, Raebel MA, Nowell WB, Curtis JR, Paolino AR, Toh S. Stakeholders' views on data sharing in multicenter studies. J Comp Eff Res 2017; 6:537-547. [PMID: 28805448 PMCID: PMC6022827 DOI: 10.2217/cer-2017-0009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To understand stakeholders' views on data sharing in multicenter comparative effectiveness research studies and the value of privacy-protecting methods. MATERIALS & METHODS Semistructured interviews with five US stakeholder groups. RESULTS We completed 11 interviews, involving patients (n = 15), researchers (n = 10), Institutional Review Board and regulatory staff (n = 3), multicenter research governance experts (n = 2) and healthcare system leaders (n = 4). Perceptions of the benefits and value of research were the strongest influences toward data sharing; cost and security risks were primary influences against sharing. Privacy-protecting methods that share summary-level data were acknowledged as being appealing, but there were concerns about increased cost and potential loss of research validity. CONCLUSION Stakeholders were open to data sharing in multicenter studies that offer value and minimize security risks.
Collapse
Affiliation(s)
- Kathleen M Mazor
- Meyers Primary Care Institute, Worcester, MA 01605, USA.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | | | - Mia Gallagher
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
| | - Marsha A Raebel
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO 80231, USA
| | - W Benjamin Nowell
- Global Healthy Living Foundation, CreakyJoints, Upper Nyack, NY 10960, USA
| | | | - Andrea R Paolino
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO 80231, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| |
Collapse
|
44
|
Mazor K, Raebel M, Arterburn D, Richards A, Gallagher M, Nowell WB, Toh D. Stakeholders’ Views on Data Sharing and Multisite Research. J Patient Cent Res Rev 2017. [DOI: 10.17294/2330-0698.1572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
45
|
Curtis JR, Chen L, Higginbotham P, Nowell WB, Gal-Levy R, Willig J, Safford M, Coe J, O'Hara K, Sa'adon R. Social media for arthritis-related comparative effectiveness and safety research and the impact of direct-to-consumer advertising. Arthritis Res Ther 2017; 19:48. [PMID: 28270190 PMCID: PMC5341200 DOI: 10.1186/s13075-017-1251-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background Social media may complement traditional data sources to answer comparative effectiveness/safety questions after medication licensure. Methods The Treato platform was used to analyze all publicly available social media data including Facebook, blogs, and discussion boards for posts mentioning inflammatory arthritis (e.g. rheumatoid, psoriatic). Safety events were self-reported by patients and mapped to medical ontologies, resolving synonyms. Disease and symptom-related treatment indications were manually redacted. The units of analysis were unique terms in posts. Pre-specified conditions (e.g. herpes zoster (HZ)) were selected based upon safety signals from clinical trials and reported as pairwise odds ratios (ORs); drugs were compared with Fisher’s exact test. Empirically identified events were analyzed using disproportionality analysis and reported as relative reporting ratios (RRRs). The accuracy of a natural language processing (NLP) classifier to identify cases of shingles associated with arthritis medications was assessed. Results As of October 2015, there were 785,656 arthritis-related posts. Posts were predominantly US posts (75%) from patient authors (87%) under 40 years of age (61%). For HZ posts (n = 1815), ORs were significantly increased with tofacitinib versus other rheumatoid arthritis therapies. ORs for mentions of perforated bowel (n = 13) were higher with tocilizumab versus other therapies. RRRs associated with tofacitinib were highest in conditions related to baldness and hair regrowth, infections and cancer. The NLP classifier had a positive predictive value of 91% to identify HZ. There was a threefold increase in posts following television direct-to-consumer advertisement (p = 0.04); posts expressing medication safety concerns were significantly more frequent than favorable posts. Conclusion Social media is a challenging yet promising data source that may complement traditional approaches for comparative effectiveness research for new medications.
Collapse
Affiliation(s)
- Jeffrey R Curtis
- The University of Alabama at Birmingham, FOT 802, 1720 2nd Ave S, Birmingham, AL, 35294-3408, USA.
| | - Lang Chen
- The University of Alabama at Birmingham, FOT 802, 1720 2nd Ave S, Birmingham, AL, 35294-3408, USA
| | - Phillip Higginbotham
- The University of Alabama at Birmingham, FOT 802, 1720 2nd Ave S, Birmingham, AL, 35294-3408, USA
| | | | | | - James Willig
- The University of Alabama at Birmingham, FOT 802, 1720 2nd Ave S, Birmingham, AL, 35294-3408, USA
| | | | - Joseph Coe
- Global Healthy Living Foundation/CreakyJoints, Upper Nyack, NY, USA
| | | | | |
Collapse
|
46
|
Abstract
Working longer is an important area of research given extended life expectancy, shortfalls of retirement income, desires to remain socially engaged, and solvency concerns of social insurance programs. The purpose of this longitudinal population-based study of older adults is to examine how different types of social resources (social bonding, bridging, and linking) relate to returning to work after retirement. Data were drawn from the Health and Retirement Study of fully retired older adults aged 62+ in 1998 ( N = 8,334) and followed to 2008. After controlling for a comprehensive set of fixed and time-varying covariates, findings suggest that social bridging (informal volunteering) and social linking (formal volunteering, partnered with an employed spouse) were strongly and positively related to returning to work (Hazard Ratio [HR]: 1.49, p < .001; HR: 1.58, p < .0001; and HR: 1.75, p < .0001, respectively). Social bonding resources were not significantly associated with returning to work. Implications for social policy are discussed.
Collapse
Affiliation(s)
- Ernest Gonzales
- School of Social Work, Boston University, Boston, MA, USA
- Center for Innovation in Social Work and Health, Boston, MA, USA
| | - W. Benjamin Nowell
- Patient-Centered Research, Global Healthy Living Foundation, Upper Nyack, NY, USA
| |
Collapse
|
47
|
Nowell WB, Merkel PA, Schanberg LE, Curtis JR. Reenergizing Research While Improving Patient Care. Provider 2016; 42:37-8, 41, 43 passim. [PMID: 27468461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
48
|
Fraenkel L, Miller AS, Clayton K, Crow-Hercher R, Hazel S, Johnson B, Rott L, White W, Wiedmeyer C, Montori VM, Singh JA, Nowell WB. When Patients Write the Guidelines: Patient Panel Recommendations for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2015; 68:26-35. [PMID: 26545701 DOI: 10.1002/acr.22758] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/20/2015] [Accepted: 10/06/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE How best to involve patients in the development of clinical practice guideline (CPG) recommendations is not known. We sought to determine the feasibility and value of developing CPG recommendations based on a voting panel composed entirely of patients, with the ultimate goal of comparing the patients' recommendations to ones developed by a physician-dominated voting panel on the same clinical questions. METHODS Ten patients with rheumatoid arthritis completed 8 hours of training on evidence-based medicine and guideline development. They constituted a voting panel and, with 2 American College of Rheumatology staff with expertise in CPG development and a physician facilitator, subsequently met at a face-to-face meeting to develop recommendations. They applied the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology to formulate recommendations on 18 questions for which there was evidence warranting moderate or high confidence. RESULTS The patient panel developed recommendations for 16 of the 18 questions; for the other 2, the panel thought there were insufficient data to support a recommendation. For 13 of the 16 questions, the patient panel recommended the same course of action as did the physician-dominated panel. Differences were due to how the 2 panels valued the balance between benefits and harms. CONCLUSION Patient and physician-dominated panels developed the same recommendations for most questions for which there was evidence warranting moderate to high confidence. Additional experiences are necessary to advance the evidence necessary to determine what panel composition is optimal to produce the best guidelines.
Collapse
Affiliation(s)
- Liana Fraenkel
- Yale University School of Medicine, New Haven, Connecticut
| | - Amy S Miller
- American College of Rheumatology, Atlanta, Georgia
| | - Kelly Clayton
- CreakyJoints, Global Healthy Living Foundation, Upper Nyack, New York
| | | | - Shantana Hazel
- CreakyJoints, Global Healthy Living Foundation, Upper Nyack, New York
| | - Britt Johnson
- CreakyJoints, Global Healthy Living Foundation, Upper Nyack, New York
| | - Leslie Rott
- CreakyJoints, Global Healthy Living Foundation, Upper Nyack, New York
| | - Whitney White
- CreakyJoints, Global Healthy Living Foundation, Upper Nyack, New York
| | - Carole Wiedmeyer
- CreakyJoints, Global Healthy Living Foundation, Upper Nyack, New York
| | | | | | | |
Collapse
|