Global Rural and Remote Patients with Rheumatoid Arthritis: A Systematic Review of Disease Epidemiology, Clinical Outcomes and Health Service Utilization

2020 ◽  
Author(s):  
Emilie Pianarosa ◽  
Kelsey Chomistek ◽  
Ralph Hsiao ◽  
Salman Anwar ◽  
Valerie Umaefulam ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Health Service ◽  
Clinical Outcomes ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Rural And Remote ◽  
Disease Epidemiology

Global Rural and Remote Patients with Rheumatoid Arthritis

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Emilie Pianarosa ◽  
Kelsey Chomistek ◽  
Ralph Hsiao ◽  
Salman Anwar ◽  
Valerie Umaefulam ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Service ◽  
Clinical Outcomes ◽  
Service Use ◽  
Care Delivery ◽  
Health Service Use ◽  
Rural And Remote ◽  
Urban Populations ◽  
Increased Risk ◽  
Diagnostic Time

Introduction: Rural and remote patients with rheumatoid arthritis (RA) are at risk for inequities in health outcomes based on differences in physical environments and healthcare access potential compared to urban populations. The aim of this systematic review was to synthesize epidemiology, clinical outcomes and health service use reported for global populations with RA residing in rural/remote locations. Methods: Medline, EMBASE, Healthstar, CINAHL and Cochrane were searched from inception to June 2019 using librarian-developed search terms for RA and rural/remote populations. Peer-reviewed published manuscripts were included if they reported on any of an epidemiology, clinical or health service use outcomes. Results: 54 articles were included for data synthesis, representing studies from all continents. In 11 studies where there was an appropriate urban population comparator, rural/remote populations were not at increased risk for RA, 1 study reported increased and 5 studies reported decreased prevalence in rural/remote populations. Clinical characteristics of rural/remote populations in studies with an appropriate urban comparator showed no significant differences in disease activity measures or disability, but with 1 study reporting worse physical function and health-related quality of life in rural/remote populations. Studies reporting on health service use provided evidence that rural/remote residence impacts diagnostic time, ongoing follow-up, access to RA-care related practitioners and services, and with variation in medication access and use. Conclusion: This synthesis highlights that RA epidemiology and clinical outcomes are not necessarily different between rural/remote and urban populations, however rural/remote patients face greater barriers to care which increases the risk for inequities in outcomes. From a public health perspective, we need leadership to implement structures and policies to support better outcomes in rural and remote populations. Access to health services is a recognized determinant of health, which presents the opportunity for actionable strategies and approaches to resolve inequities in care delivery.

scholarly journals A multicenter study of annual health service utilization and costs in rheumatoid arthritis

1986 ◽  
Vol 29 (4) ◽  
pp. 488-493 ◽  
Author(s):  
Deborah P. Lubeck ◽  
Patricia W. Spitz ◽  
James F. Fries ◽  
Frederick Wolfe ◽  
Donald M. Mitchell ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Service ◽  
Service Utilization ◽  
Multicenter Study ◽  
Health Service Utilization

scholarly journals Outcomes of a Heart Failure Telemonitoring Program Implemented as the Standard of Care in an Outpatient Heart Function Clinic: Pretest-Posttest Pragmatic Study (Preprint)

2019 ◽  
Author(s):  
Patrick Ware ◽  
Heather J Ross ◽  
Joseph A Cafazzo ◽  
Chris Boodoo ◽  
Mikayla Munnery ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Service ◽  
Clinical Outcomes ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Heart Function ◽  
Self Care ◽  
Standard Of Care ◽  
Program Enrollment ◽  
Secondary Outcomes

BACKGROUND Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decisions. The <i>Medly</i> program enables patients to use a mobile phone to record daily HF readings and receive personalized self-care messages generated by a clinically validated algorithm. The TM system also generates alerts, which are immediately acted upon by the patients’ existing care team. This program has been operating for 3 years as part of the standard of care in an outpatient heart function clinic in Toronto, Canada. OBJECTIVE This study aimed to evaluate the 6-month impact of this TM program on health service utilization, clinical outcomes, quality of life (QoL), and patient self-care. METHODS This pragmatic quality improvement study employed a pretest-posttest design to compare 6-month outcome measures with those at program enrollment. The primary outcome was the number of HF-related hospitalizations. Secondary outcomes included all-cause hospitalizations, emergency department visits (HF related and all cause), length of stay (HF related and all cause), and visits to the outpatient clinic. Clinical outcomes included bloodwork (B-type natriuretic peptide [BNP], creatinine, and sodium), left ventricular ejection fraction, and predicted survival score using the Seattle Heart Failure Model. QoL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the 5-level EuroQol 5-dimensional questionnaire. Self-care was measured using the Self-Care of Heart Failure Index (SCHFI). The difference in outcome scores was analyzed using negative binomial distribution and Poisson regressions for the health service utilization outcomes and linear regressions for all other outcomes to control for key demographic and clinical variables. RESULTS Available data for 315 patients enrolled in the TM program between August 2016 and January 2019 were analyzed. A 50% decrease in HF-related hospitalizations (incidence rate ratio [IRR]=0.50; <i>P</i>&lt;.001) and a 24% decrease in the number of all-cause hospitalizations (IRR=0.76; <i>P</i>=.02) were found when comparing the number of events 6 months after program enrollment with the number of events 6 months before enrollment. With regard to clinical outcomes at 6 months, a 59% decrease in BNP values was found after adjusting for control variables. Moreover, 6-month MLHFQ total scores were 9.8 points lower than baseline scores (<i>P</i>&lt;.001), representing a clinically meaningful improvement in HF-related QoL. Similarly, the MLHFQ physical and emotional subscales showed a decrease of 5.4 points (<i>P</i>&lt;.001) and 1.5 points (<i>P</i>=.04), respectively. Finally, patient self-care after 6 months improved as demonstrated by a 7.8-point (<i>P</i>&lt;.001) and 8.5-point (<i>P</i>=.01) increase in the SCHFI maintenance and management scores, respectively. No significant changes were observed in the remaining secondary outcomes. CONCLUSIONS This study suggests that an HF TM program, which provides patients with self-care support and active monitoring by their existing care team, can reduce health service utilization and improve clinical, QoL, and patient self-care outcomes.

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