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Care for Rheumatoid Arthritis Patients in BC: The Impact of Care Gaps

This study is currently in its analysis stage.  

Principal Investigators:

Diane Lacaille, MD, MHSc, FRCPC, Mary Pack Chair in Arthritis Research Senior Research Scientist, Arthritis Research Canada Professor, University of British Columbia

Why do this research?

In previous research we found unacceptably low use of disease-modifying anti-rheumatic drugs (DMARDs) in British Columbia, despite being recommended for all patients with active rheumatoid arthritis (RA). Rheumatologist care was shown to greatly influence how patients with RA are treated, yet many RA patients are never referred to rheumatologists. This study aims to determine the real health impact of these gaps in care. We are evaluating how variations in RA care and treatment strategies impact outcomes important to people with arthritis, such as physical function, risk of work loss, and premature death. Our results will provide evidence to help policy-makers, clinicians and people with arthritis evaluate and make informed decisions about health care services.

What was found?

Using administrative data from the BC Ministry of Health, we have been able to evaluate the impact of certain RA treatments on the health of people living with RA. We found that people who receive biologic medications, a relatively new class of disease-modifying drugs, have a significantly lower risk of death than people who don’t. On the other hand, we found that patients treated with glucocorticoids, a type of medication used to combat inflammation, have a significantly higher risk of death. We are currently evaluating other aspects of health care and how they influence health outcomes in RA.

How is this study being conducted?

We used administrative data from the BC Ministry of Health to collect information on treatments received for RA including timing and consistency of DMARD use, and use of different DMARD treatment strategies. We analyzed the relationships between the use of these medications and the risk of certain health outcomes. For the past 10 years we have been following a cohort of people with RA in BC. Each year, these individuals complete questionnaires that help us to determine their RA disease activity, physical function and overall health-related quality of life. The relationship between variations in RA care and health outcomes is being analyzed. Growing emphasis on patient-centered health care delivery requires patients and clinicians to make health care decisions together, allowing patients to make decisions that take into consideration health outcomes that matter to them. Findings from this study will be useful in educating clinicians and empowering patients to make informed decisions and hopefully improve the care and outcomes of RA.

Funding Agency

This research is funded by the Canadian Institutes of Health Research.

Co-investigators

John Esdaile, MD, MPH, FRCPC Scientific Director, Arthritis Research Canada Professor, University of British Columbia Michal Abrahamowicz, PhD James McGill Professor, Epidemiology, Biostatistics and Occupational Health, McGill University Pam Rogers, MA Research Coordinator, Arthritis Research Canada

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