July 16, 2013
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RA patients’ care standards varied at Montreal teaching hospitals

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At university-affiliated teaching hospitals in Montreal, a quality indicator assessment found mixed results on adherence to standards of care for patients with rheumatoid arthritis in a recent study.

Sasha Bernatsky, MD, PhD, FRCPC, of the division of clinical epidemiology, Research Institute at the McGill University Health Centre, and fellow researchers audited charts and electronic records of 76 patients fulfilling 2010 American College of Rheumatology-European League Against Rheumatism criteria for rheumatoid arthritis (RA; mean age, 55 years; majority women) at two university-affiliated network of teaching hospitals to determine quality indicators.

Sasha Bernatsky, MD 

Sasha Bernatsky

“Logistic multivariate regression analyses were performed to investigate potential determinants of nonadherence and propose measures to facilitate better quality indicator [QI] compliance, as a potential strategy toward RA care improvement,” the researchers wrote.

QIs mandating disease-modifying antirheumatic drug therapy for all patients were consistent, along with those assessing drug adjustment for disease activity, prednisone tapering and bisphosphonate therapy if indicated for patients on glucocorticoids. QIs that measured radiographic performance, functional capacity, and hepatitis and tuberculosis screening before methotrexate and biologics were commenced, respectively, displayed a lack of documentation or inconsistent adherence. There was no independent association with studied variables found in the QIs analyzed.

“Strategies to optimize the implementation and documentation of those found least complied to, including functional capacity measurement and pre-DMARD screening, could improve RA care,” the researchers concluded. “Radiographic disease monitoring, while lacking, may represent a move toward other more sensitive methods of RA progression detection, such as joint ultrasound. The inclusion of patient- and physician-derived information could help elucidate the reasons underlying nonadherence.”