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

Irazú Contreras-Yáñez, Virginia Pascual-Ramos, Irazú Contreras-Yáñez, Virginia Pascual-Ramos

Abstract

Background: 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.

Methods: 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.

Results: 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 <50% emerged as predictors of HDO. Five cases returned back after (median, range) drop out time of 3.8 years (2.3-5.8); they exhibited higher disability and poorer function than paired controls and outcomes were sustained up to their last follow-up.

Conclusions: In a real clinical setting of an EAC, failure to control disease activity, intensive treatment and poor persistence with therapy predicted HDO. Abandonment of health care had a negative impact on patient outcomes and was sustained even after health care was reinitiated.

Keywords: Patient attitude to health; Quality of health care; Rheumatoid arthritis.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by Internal Review Board: “Comité de Ética en Investigación del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán”, with the reference number: 274.

All patients provided an informed written consent to participate in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Impact of HDO on health related quality of life outcomes. Comparison of HAQ (upper panel) and SF-36 (bottom panel) scores (median, [Q25-Q75]) between cases (patients with HDO) and controls (patients compliant with schedule visits) at health care re-initiate and at last follow-up

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