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Rheumatology International

, Volume 38, Issue 3, pp 499–505 | Cite as

A comprehensive care program achieves high remission rates in rheumatoid arthritis in a middle-income setting. Experience of a Center of Excellence in Colombia

  • Pedro Santos-Moreno
  • Nelson J. Alvis-Zakzuk
  • Laura Villarreal-Peralta
  • Maria Carrasquilla-Sotomayor
  • Angel Paternina-Caicedo
  • Nelson Alvis-Guzmán
Health Services Research

Abstract

Management of rheumatoid arthritis (RA) in many Latin-American countries is impaired by fragmentation and scarce healthcare provision, resulting in obstacles to access, diagnosis, and treatment, and consequently in poor health outcomes. The aim of this study is to propose a comprehensive care program as a model to provide healthcare to RA patients receiving synthetic DMARDs in a Colombian setting by describing the model and its results. Health outcomes were prospectively collected in all patients entering the program. By protocol, patients are followed up during 24 months using a treat-to-target strategy with a patient-centered care (PCC) model, meaning that a patient should be seen by rheumatologist, physical and occupational therapist, physiatrist, nutritionist and psychologist, at least three times a year according to disease activity by DAS28. Otherwise, patients receive standard therapy. The incidence of remission and low disease activity (LDA) was calculated by periods of follow-up. A total of 968 patients entered the program from January 2015 to December 2016; 80.2% were women. At baseline, 41% of patients were in remission, 17% in LDA and 42% in MDS/SDA. At 24 months of follow-up, 66% were in remission, 18% in LDA and only 16% in MDS/SDA. Regarding DAS28, the mean at the beginning of the time analysis was 3.1 (SD 1.0) and after 24 months it was 2.4 (SD 0.7), showing a statistically significant improvement (p < 0.001). In all patients, the reduction of disease activity was 65% (95% CI, 58–71). Patients entering the PCC program benefited from a global improvement in disease activity in terms of DAS28.

Keywords

Rheumatoid arthritis Treat to target Patient-centered care Center of excellence 

Notes

Author contributions

PS-M designed the study, collected the data, reviewed the drafted manuscript, and approved the final manuscript for submission. NA-Z and NA-G designed the study, drafted the manuscript, carried out analysis, and approved the final manuscript. MC-S helped carrying out analysis, reviewed the drafted manuscript, and approved the final manuscript. AP-C helped carrying out analysis, reviewed the drafted manuscript, and approved the final manuscript, and LV-P helped collected the data, reviewed the drafted manuscript, and approved the final manuscript. All authors assume the integrity of the content of the manuscript.

Compliance with ethical standards

Conflict of interest

Pedro Santos-Moreno, Nelson J. Alvis-Zakzuk, Laura Villarreal-Peralta, Maria Carrasquilla-Sotomayor, Angel Paternina-Caicedo and Nelson Alvis-Guzmán declare that they have no conflict of interest.

Funding

No funding was received.

References

  1. 1.
    Alamanos Y, Drosos AA (2005) Epidemiology of adult rheumatoid arthritis. Autoimmun Rev 4:130–136.  https://doi.org/10.1016/j.autrev.2004.09.002 CrossRefPubMedGoogle Scholar
  2. 2.
    Epstein FH, Choy EHS, Panayi GS (2001) Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med 344:907–916.  https://doi.org/10.1056/NEJM200103223441207 CrossRefGoogle Scholar
  3. 3.
    Barreto SM, Miranda JJ, Figueroa JP et al (2012) Epidemiology in Latin America and the Caribbean: current situation and challenges. Int J Epidemiol 41:557–571CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Santos-Moreno P, Galarza-Maldonado C, Caballero-Uribe CV et al (2015) REAL-PANLAR project for the implementation and accreditation of centers of excellence in rheumatoid arthritis throughout Latin America. JCR J Clin Rheumatol 21:175–180.  https://doi.org/10.1097/RHU.0000000000000247 CrossRefPubMedGoogle Scholar
  5. 5.
    Al Maini M, Adelowo F, Al Saleh J et al (2015) The global challenges and opportunities in the practice of rheumatology: white paper by the world forum on rheumatic and musculoskeletal diseases. Clin Rheumatol 34:819–829CrossRefPubMedGoogle Scholar
  6. 6.
    Fondo Colombiano de Enfermendades de Alto Costo-Cuenta de Alto Costo [CAC] (2017) Situación de la artritis reumatoide en Colombia 2016. Bogotá D.C. https://cuentadealtocosto.org/site/index.php. Accessed 24 Oct 2017
  7. 7.
    Kumar K, Peters S, Barton A (2016) Rheumatoid arthritis patient perceptions on the value of predictive testing for treatments: a qualitative study. BMC Musculoskelet Disord 17(1):460CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Organización Panamericana de la Salud-OPS (2012) Redes integradas de servicios de salud. http://www.paho.org/%0Ahq/index.php?option=com_content&view=category&layout=%0Ablog&id=3184&Itemid=3553&lang=es. Accessed 30 ene 2017
  9. 9.
    Santos-Moreno P, Castañeda O, Garro B et al (2015) From the model of integral attention to the creation of centers of excellence in rheumatoid arthritis. Clin Rheumatol 34(Suppl 1):S71–S77.  https://doi.org/10.1007/s10067-015-3017-8 CrossRefPubMedGoogle Scholar
  10. 10.
    Smolen JS, Aletaha D, Bijlsma JWJ et al (2012) Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 69:631–637.  https://doi.org/10.1136/ard.2009.123919 CrossRefGoogle Scholar
  11. 11.
    Smolen. JS, Breedveld. FC, Burmester GR et al (2015) Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis 0:1–13Google Scholar
  12. 12.
    Ministerio de Salud y Protección Social Resolución 1393 de 2015. https://cuentadealtocosto.org/site/images/Resolucion1393 de 2015-ARTRITIS.pdf. Accessed 25 Oct 2017
  13. 13.
    Ministerio de Salud y Protección Social—Ministerio de Hacienda y Crédito Público Cuenta de Alto Costo. https://cuentadealtocosto.org/site/index.php. Accessed 25 Oct 2017
  14. 14.
    Ministerio de Salud y Protección Social (2014) Guía de Práctica Clínica para la detección temprana, diagnóstico y tratamiento de la artritis reumatoide. https://cuentadealtocosto.org/site/index.php. Accessed 24 Oct 2017
  15. 15.
    Fransen J, Van Riel P (2005) The disease activity score and the EULAR response criteria. Clin Exp Rheumatol 23:S93PubMedGoogle Scholar
  16. 16.
    Szklo M, Nieto FJ (2014) Epidemiology: beyond the basics. Jones & Bartlett Learning, Burlington, VTGoogle Scholar
  17. 17.
    Ministerio de Salud y Protección Social Resolución Número 8430 de 1993. https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF. Accessed 25 Oct 2017
  18. 18.
    Tan BE, Lim AL, Kan SL et al (2017) Management of rheumatoid arthritis in clinical practice using treat-to-target strategy: Where do we stand in the multi-ethnic Malaysia population? Rheumatol Int.  https://doi.org/10.1007/s00296-017-3705-6 Google Scholar
  19. 19.
    de Andrade NPB, da Silva Chakr RM, Xavier RM et al (2017) Long-term outcomes of treat-to-target strategy in established rheumatoid arthritis: a daily practice prospective cohort study. Rheumatol Int.  https://doi.org/10.1007/s00296-017-3695-4 Google Scholar
  20. 20.
    Wabe N, Wiese MD (2016) Treating rheumatoid arthritis to target: physician and patient adherence issues in contemporary rheumatoid arthritis therapy. J Eval Clin Pract.  https://doi.org/10.1111/jep.12620 PubMedGoogle Scholar
  21. 21.
    BRAND C, HUNTER D, HINMAN R et al (2011) Improving care for people with osteoarthritis of the hip and knee: how has national policy for osteoarthritis been translated into service models in Australia? Int J Rheum Dis 14:181–190.  https://doi.org/10.1111/j.1756-185X.2011.01613.x CrossRefPubMedGoogle Scholar
  22. 22.
    Puchner R, Hochreiter R, Pieringer H, Vavrovsky A (2017) Improving patient flow of people with rheumatoid arthritis has the potential to simultaneously improve health outcomes and reduce direct costs. BMC Musculoskelet Disord 18:7.  https://doi.org/10.1186/s12891-016-1362-7 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Fagnani F, Pham T, Claudepierre P et al (2016) Modeling of the clinical and economic impact of a risk-sharing agreement supporting a treat-to-target strategy in the management of patients with rheumatoid arthritis in France. J Med Econ 19:812–821.  https://doi.org/10.1080/13696998.2016.1176576 CrossRefPubMedGoogle Scholar
  24. 24.
    Speerin R, Slater H, Li L et al (2014) Moving from evidence to practice: models of care for the prevention and management of musculoskeletal conditions. Best Pract Res Clin Rheumatol 28:479–515.  https://doi.org/10.1016/j.berh.2014.07.001 CrossRefPubMedGoogle Scholar
  25. 25.
    Gunnarsson C, Chen J, Rizzo JA et al (2015) The employee absenteeism costs of rheumatoid arthritis. J Occup Environ Med 57:635–642.  https://doi.org/10.1097/JOM.0000000000000461 CrossRefPubMedGoogle Scholar
  26. 26.
    Voshaar MJH, Nota I, van de Laar MAFJ., van den Bemt BJF (2015) Patient-centred care in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 29:643–663.  https://doi.org/10.1016/j.berh.2015.09.007 CrossRefPubMedGoogle Scholar
  27. 27.
    Weinberg DB, Cooney-Miner D, Perloff JN et al (2011) Building collaborative capacity: promoting interdisciplinary teamwork in the absence of formal teams. Med Care 49:716–723.  https://doi.org/10.1097/MLR.0b013e318215da3f CrossRefPubMedGoogle Scholar
  28. 28.
    Coulter A, Ellins J (2007) Effectiveness of strategies for informing, educating, and involving patients. BMJ 335:24–27.  https://doi.org/10.1136/bmj.39246.581169.80 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Frampton S, Guastello S, Brady C et al (2008) Patient-centered care improvement guide. CT Planetree, DerbyGoogle Scholar
  30. 30.
    Elwyn G, Laitner S, Coulter A et al (2010) Implementing shared decision making in the NHS. BMJ 341:c5146CrossRefPubMedGoogle Scholar
  31. 31.
    Kremer JA, van der Eijk M, Aarts JW, Bloem BR (2015) The individual formerly known as patient. Patient-centered care 99Google Scholar
  32. 32.
    van der Eijk M, Nijhuis FAP, Faber MJ, Bloem BR (2013) Moving from physician-centered care towards patient-centered care for Parkinson’s disease patients. Parkinsonism Relat Disord 19:923–927CrossRefPubMedGoogle Scholar
  33. 33.
    Sevin C, Moore G, Shepherd J et al (2009) Transforming care teams to provide the best possible patient-centered, collaborative care. J Ambul Care Manage 32:24–31.  https://doi.org/10.1097/01.JAC.0000343121.07844.e0 CrossRefPubMedGoogle Scholar
  34. 34.
    Bensing J (2000) Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine. Patient Educ Couns 39:17–25CrossRefPubMedGoogle Scholar
  35. 35.
    Park DC, Hertzog C, Leventhal H et al (1999) Medication adherence in rheumatoid arthritis patients: older is wiser. J Am Geriatr Soc 47:172–183.  https://doi.org/10.1111/j.1532-5415.1999.tb04575.x CrossRefPubMedGoogle Scholar
  36. 36.
    Jaillier JCR, Arango AMP, Pérez DAM (2015) Challenges faced in Latin America for the implementation of an ideal health-care model for rheumatoid arthritis patients: are we ready? Clin Rheumatol 34:79–93.  https://doi.org/10.1007/s10067-015-3034-7 CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.BIOMAB Rheumatoid Arthritis CenterBogotá, D.C.Colombia
  2. 2.ALZAK FoundationCartagenaColombia
  3. 3.Grupo de Investigación en Epidemiología y Salud PoblacionalCartagenaColombia
  4. 4.Grupo de Investigación en Gestión Hospitalaria y Políticas de Salud. Universidad de la CostaBarranquillaColombia
  5. 5.Grupo de Investigación en Economía de la Salud. Universidad de CartagenaCartagenaColombia

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