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Does healthcare regime affiliation influence the clinical outcomes of patients with rheumatoid arthritis?

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Abstract

Background/purpose

Adequate control of disease activity in rheumatoid arthritis (RA) depends, to a great extent, on the access to a rheumatologist. This study aimed to compare the disease outcomes of patients with RA, based on their healthcare regime affiliation.

Methods

A retrospective observational study of Colombian patients with RA in three outpatient services of different regimes: Contributory (CR, workers and their families with a monthly income above a yearly defined threshold, approximately US$ 220, who allocate a percentage of their income to financing the national health fund and to get access to healthcare services), subsidized (SR, a vulnerable population with a monthly income below the threshold, who have access to healthcare through the national health fund; comparable to the USA Medicaid population), and an excellence clinical care center (C3, access to specialized care, regardless of their healthcare affiliation regime). Data were collected from clinical records for 2 years of follow-up and included demographics, lag times between appointments, and time in high disease activity. We used the Mantel-Cox test for the analysis of time to remission/low disease activity.

Results

A total of 240 patients were included (80 patients per regime). At the start of follow-up, mean age was 53.7 years; 21.6% of patients were men; 79.6% of patients had established RA; 72.9% of patients had high disease activity. Patients in the CR had longer lag times between scheduled appointments (p < 0.0001). During follow-up, SR had the highest proportion of patients with high disease activity. Survival curve analysis showed no significant difference between SR and CR groups (p = 0.2903), but was significantly different compared with the C3 group (p < 0.0001). Median survival in high disease activity was greater in the SR group (293 days), followed by CR (254 days), and finally by C3 (64 days).

Conclusion

Patients that were treated in the excellence clinical care center had better outcomes when compared with other regimes. These data support that healthcare regime may influence disease outcome in patients with RA.

Key Points

• Prompt access to healthcare in patients with rheumatoid arthritis is pivotal for an adequate control of the disease, for timely adjustment of treatment, and to reduce both the societal burden of the disease and its impact on individual well-being.

• As an example of “structural iatrogenesis,” healthcare regime affiliation appears to influence disease outcomes in patients with rheumatoid arthritis, in whom differences between regimes are observed. The most vulnerable patients appear to experience the worst outcomes.

• Excellence clinical care centers for patients with rheumatoid arthritis should be implemented as an alternative to counteract structural healthcare barriers and as an approach to improve clinical outcomes through a tighter disease control.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

We want to thank Dr. Cosmo Fowler, Dr. Alejandro De la Hoz, and Dr. Myriam Frydman for their time and insights on our manuscript.

Code availability

Not applicable.

Funding

This study was supported by a grant from the Colombian Association of Rheumatology.

Author information

Authors and Affiliations

  1. School of Medicine, Pontificia Universidad Javeriana, Bogotá, DC, Colombia

    Julián E. Barahona-Correa

  2. Reumavance Group, Section of Rheumatology, Fundación Santa Fé de Bogotá University Hospital, Bogotá, DC, Colombia

    Julián E. Barahona-Correa, Jorge Flórez-Suárez, Paola Coral-Alvarado, Paul Méndez-Patarroyo & Gerardo Quintana-López

  3. School of Medicine, Universidad de Los Andes, Bogotá, DC, Colombia

    Paola Coral-Alvarado, Paul Méndez-Patarroyo & Gerardo Quintana-López

  4. School of Medicine, Universidad Nacional de Colombia, Bogotá, DC, Colombia

    Gerardo Quintana-López

  5. Department of Internal Medicine, Fundación Santa Fe de Bogotá University Hospital, Carrera 7 No. 117-15, 220246, Bogota, DC, Colombia

    Gerardo Quintana-López

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  1. Julián E. Barahona-Correa
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  2. Jorge Flórez-Suárez
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  3. Paola Coral-Alvarado
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Contributions

All authors contributed to the conception and design of the study. Material preparation, data collection, and analysis were performed by Julián E. Barahona-Correa, Jorge Flórez-Suárez, and Gerardo Quintana-López. The manuscript was drafted by Julián E. Barahona-Correa and Jorge Flórez-Suárez and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gerardo Quintana-López.

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Ethics approval

As a descriptive non-interventional study, this study was considered a no-risk research; thus, a waiver of written informed consent was obtained. The collected data were de-identified and handled by authorized study personnel. Data were used for research purposes only, in agreement with the Helsinki declaration and resolution number 008430 of 1993 issued by the Ministry of Health from the Republic of Colombia.

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Transparency disclosure: The present work is an expansion of a prior interim analysis that is being considered for publication in the Colombian Journal of Rheumatology. This interim analysis was submitted as it received an award in the Colombian Congress of Rheumatology that requested, as a condition, to submit a manuscript with the presented data to the journal. The results of the present work have been published as an abstract in conference proceedings or submitted as interim analysis, in the following references:

ACR Annual Meeting 2019

Barahona-Correa J, et al. Differences in Clinical Outcomes According to the Healthcare Regime in Colombian Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). (Abstract number: 1156) https://acrabstracts.org/abstract/differences-in-clinical-outcomes-according-to-the-healthcare-regime-in-colombian-patients-with-rheumatoid-arthritis/.

Colombian Congress of Rheumatology

Barahona-Correa JE, et al. Diferencias en la oportunidad de acceso y desenlaces de pacientes con artritis reumatoide en distintos regímenes de salud en Colombia. Rev. Colomb Reumatol. 2019; 26 (Supl Congr): 17. (Abstract number: 22) https://www.elsevier.es/es-revista-revista-colombiana-reumatologia-374-pdf-X0121812319636366

Colombian Journal of Rheumatology - Interim analysis submission (Short communication)

Submission number: RCREU-D-20-00036

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Barahona-Correa, J.E., Flórez-Suárez, J., Coral-Alvarado, P. et al. Does healthcare regime affiliation influence the clinical outcomes of patients with rheumatoid arthritis?. Clin Rheumatol 40, 877–886 (2021). https://doi.org/10.1007/s10067-020-05347-2

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