Predictors of health care drop-out in an inception cohort of patients with early onset rheumatoid arthritis

• Published in: BMC musculoskeletal disorders 2017-07, Vol.18 (1), p.321-321, Article 321
• Main Authors: Contreras-Yáñez, Irazú, Pascual-Ramos, Virginia
• Format: Article
• Language: English
• Subjects: Adult; Age of Onset; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - epidemiology; Arthritis, Rheumatoid - psychology; Care and treatment; Case-Control Studies; Cohort Studies; Family medical history; Female; Humans; Male; Medical care; Mexico - epidemiology; Middle Aged; Musculoskeletal diseases; Patient attitude to health; Patient Dropouts - statistics & numerical data; Patients; Quality management; Quality of health care; Regression analysis; Rheumatoid arthritis; Rheumatology; Schedules; Severity of Illness Index
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-017-1670-6

RA patients who eventually dropped out of treatment and out of the health care system had potentially disastrous consequences for their health-related quality-of-life outcomes. Objectives of the study were to identify predictors of health care drop out (HDO) in an inception and ongoing cohort of patients with recent onset RA. Charts from patients attending an early arthritis clinic from February 2004 to December 2015, and standardized follow-up evaluations were reviewed. Patients with HDO (cases) were defined when they did not return back to the clinic for a schedule visit for at least one year. Persistence with therapy was defined as length of time patients complied with RA-treatment. A case-control nested within a cohort design was used to compare baseline and cumulative (up to HDO or equivalent follow-up) variables between cases and paired controls (patients compliant with scheduled visits). Cox regression analysis was used to investigate predictors of HDO. The study was approved by the Institutional Review Board and patients gave written informed consent to have their data published. Data from 170 patients (89.4% female, [mean±SD] age: 38.2±12.6 years) with ≥1 year of follow-up were analyzed; up to December 2015, (median, interquartile rage) follow-up was 86.6 months (43.2-123) during which 35 (20.6%) patients had HDO after 41.1 months (12.1-58.7). Baseline and cumulative variables related to disease activity, treatment and persistence with therapy entered regression models; cumulative number of flares, number of disease-modifying anti-rheumatic drugs /patient and persistence