Advertisement

Clinical Rheumatology

, Volume 32, Issue 1, pp 49–59 | Cite as

The effect of the Arthritis Self-Management Program on outcome in African Americans with rheumatoid arthritis served by a public hospital

  • Doyt L. Conn
  • Yi Pan
  • Kirk A. Easley
  • Dawn L. Comeau
  • Joyce P. Carlone
  • Steven D. Culler
  • Athan Tiliakos
Original Article

Abstract

The purpose of the study was to determine the effect of the Arthritis Self-Management Program (ASMP) on a cohort of patients, primarily African American (90 %), with rheumatoid arthritis (RA) served by a public hospital. One hundred four patients were randomly assigned to the ASMP group or the usual care group and followed for 18 months. The primary endpoint was clinical improvement indicated by the American College of Rheumatology (ACR20). Focus groups were conducted to provide contextual data. The percentages of patients achieving ACR20 were similar in the ASMP (14 % at 18 months) and usual care (17 %) groups (p = 0.3). However, 28 % of the 25 ASMP patients that attended four or more classes achieved ACR 20 after 18 months of follow-up, but only 5 % of the 27 ASMP patients that attended less than four classes achieved ACR20 (P = 0.1). There was a reduction in the tender and swollen joints in both groups over time (P = 0.02), and those aged 60 and over had fewer joints involved. Half of the cohort fell at or below the poverty level. The percentages of patients achieving ACR20 were similar in the ASMP and usual care groups. Patients who attended four or more ASMP classes improved the most, but included only half of those assigned to ASMP. This suggests a need for innovative participant retention strategies or a different type of self-management program for this population.

Keywords

African Americans Clinical outcomes Patient self-management Rheumatoid arthritis 

Notes

Acknowledgments

This study was supported by The Physicians Foundation Grant No. 9600564.

Disclosures

None

References

  1. 1.
    Suarez-Almazor ME, Berrios-Revera JP, Cox V, Janssen NM, Marcus DM, Sessoms S (2007) Initiation of disease-modifying antirheumatic drug therapy in minority and disadvantaged patients with rheumatoid arthritis. J Rheumatol 34:2320–2322Google Scholar
  2. 2.
    Iren UT, Walker MS, Hochman E, Brasington R (2005) A pilot study to determine whether disability and disease activity are different in African American and Caucasian patients with rheumatoid arthritis in St. Louis, Missouri, USA. J Rheumatol 32(4):602–608PubMedGoogle Scholar
  3. 3.
    3ERAS Study Group (2000) Socioeconomic deprivation and rheumatoid disease: what lessons for the health service? Ann Rheum Dis 59:793–799Google Scholar
  4. 4.
    Barton JL, Trupin L, Schillinger D, Gansky SA, Tonner C, Margaretten M et al (2011) Racial and ethnic disparities in disease activity and function among persons with rheumatoid arthritis from university affiliated clinics. Arthritis Care Res 63:1238–1246CrossRefGoogle Scholar
  5. 5.
    Wolfe F (2000) A reappraisal of HAQ disability in rheumatoid arthritis. Arthritis Rheum 43:2751–2761PubMedCrossRefGoogle Scholar
  6. 6.
    Michaud K, Wallenstein G, Wolfe F (2011) Treatment and non-treatment predictors of health assessment questionnaire disability progression in rheumatoid arthritis: a longitudinal study of 18,485 patients. Arthritis Care Res 63:366–372Google Scholar
  7. 7.
    Möttönen T, Hannonen P, Leirisalo-Repo M, Nissilä M, Kautiainen H, Korpela M et al, for the FIN-RACo trial group (1999) Comparison of combination therapy with single drug therapy in early rheumatoid arthritis: a randomized trial. Lancet 353:1568–1573CrossRefGoogle Scholar
  8. 8.
    Wiles NJ, Lunt M, Barrett EM, Bukhari M, Silman AJ, Symmons DPM et al (2001) Reduced disability at five years with early treatment of inflammatory polyarthritis. Arthritis Rheum 44:1033–1042PubMedCrossRefGoogle Scholar
  9. 9.
    Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH, Keystone EC et al (2000) A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med 343:1586–1593PubMedCrossRefGoogle Scholar
  10. 10.
    Lorig KR, Mazonson PD, Holman HR (1993) Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 36:439–446PubMedCrossRefGoogle Scholar
  11. 11.
    Lorig K, Ritter PL, Plant K (2005) A disease specific self-help program compared with a generalized chronic disease self-help program for arthritis patients. Arthritis Care Res 53:950–957CrossRefGoogle Scholar
  12. 12.
    Patel A, Buszewicz M, Beecham J, Griffin M, Rait G et al (2009) Economic evaluation of arthritis self management in primary care. Br Med J 339:b3532CrossRefGoogle Scholar
  13. 13.
    Solomon D, Warsi A, Brown-Stevenson T, Farrell M, Gauthier S, Mikels D, Lee T (2002) Does self-management education benefit all populations with arthritis? A randomized controlled trial in a primary care physician network. J Rheumatol 29:362–368PubMedGoogle Scholar
  14. 14.
    Warsi A, Wang P, LaValley M, Avorn J, Solomon D (2004) Self-management education programs in chronic disease. Arch Intern Med 164:1641–1649PubMedCrossRefGoogle Scholar
  15. 15.
    Kroll T, Barbour R, Harris J (2007) Using focus groups in disability research. Qual Health Res 17:690–698PubMedCrossRefGoogle Scholar
  16. 16.
    Stamm T, Alarcos C, Coenen M, Machold K, Nell V, Smolen J et al (2005) Validating the international classification of functioning, disability and health comprehensive core set for rheumatoid arthritis from the patient perspective: a qualitative study. Arthritis Care Res 53:431–439CrossRefGoogle Scholar
  17. 17.
    Stamm T, Lovelock L, Nell V, Smolen J, Jonsson H, Sadlo G et al (2008) I have mastered the challenge of living with a chronic disease: life stories of people with rheumatoid arthritis. Qual Health Res 18:658–669PubMedCrossRefGoogle Scholar
  18. 18.
    Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324PubMedCrossRefGoogle Scholar
  19. 19.
    Felson DT, Anderson JJ, Boers M, Bombardier C, Furst D, Goldsmith C et al (1999) American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum 38:727–735CrossRefGoogle Scholar
  20. 20.
    Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36): conceptual framework and item selection. Med Care 30:473–483PubMedCrossRefGoogle Scholar
  21. 21.
    DeVellis RF, Callahan LF (1993) A brief measure of helplessness in rheumatic disease: the helplessness subscale of the Rheumatology Attitudes Index. J Rheumatol :866–890Google Scholar
  22. 22.
    Fries BBJF (2005) The Health Assessment Questionnaire (HAQ). Clin Exp Rheumatol 23(Suppl 39):14–18Google Scholar
  23. 23.
    Diggle P, Liang KY, Zeger SL (1994) Analysis of longitudinal data. Clarendon, New YorkGoogle Scholar
  24. 24.
    Liang KY, Zeger SL (1986) Longitudinal data analysis using generalized linear models. Biometrika 73:13–22CrossRefGoogle Scholar
  25. 25.
    The HHS poverty guidelines for the remainder of 2010 (2010) http://aspe.hhs.gov/poverty/10poverty.shtml. Accessed June 2011.
  26. 26.
    McEntegart A, Morrison E, Capell HA, Duncan MR, Porter D, Madhok R et al (1997) Effect of social deprivation on disease disparity and outcome in patients with rheumatoid arthritis. Ann Rheum Dis 56:410–413PubMedCrossRefGoogle Scholar
  27. 27.
    Bruce B, Fries JF, Murtagh KN (2007) Health status disparities in ethnic minority patients with rheumatoid arthritis: a cross-sectional study. J Rheumatol 34:1475–1479PubMedGoogle Scholar
  28. 28.
    Harrison MJ, Farragher TM, Clarke AM, Manning SC, Bunn DK, Symmons DPM (2009) Association of functional outcome with both personal- and area-level socioeconomic inequalities in patients with inflammatory polyarthritis. Arthritis Rheum 61:1297–1304PubMedCrossRefGoogle Scholar
  29. 29.
    Song J, Chang HJ, Tirodkar M, Chang RW, Manheim LM, Dunlop DD (2007) Racial/ethnic differences in activities in daily living disability in older adults with arthritis: a longitudinal study. Arthritis Rheum 57:1058–1066PubMedCrossRefGoogle Scholar
  30. 30.
    Lorig K, Ritter P, Stewart A, Sobel D, Brown B et al (2001) Chronic disease self-management program. Med Care 39:1217–1223PubMedCrossRefGoogle Scholar
  31. 31.
    Goeppinger J, Armstrong B, Schwartz T, Ensley D, Brady TJ (2007) Self-management education for persons with arthritis: managing co-morbidity and eliminating health disparities. Arthritis Rheum 57:1081–1088PubMedCrossRefGoogle Scholar
  32. 32.
    Grønning K, Skomsvoll J, Rannestad I, Steinbekk A (2011) The effect of an educational programme consisting of group and individual arthritis education for patients with polyarthritis—a randomized controlled trial. Patient Educ Couns. doi: 10.1016/j.pec2011.12.011
  33. 33.
    Hammond A, Bryan J, Hardy A (2008) Effects of a modular behavioral arthritis education programme: a pragmatic parallel-group randomized controlled trial. Rheumatol 47:1712–1718CrossRefGoogle Scholar
  34. 34.
    Riemsma R, Taal E, Kirwon J, Rasker J (2004) Systematic review of rheumatoid arthritis patient education. Arthritis Car Res 51:1045–1059CrossRefGoogle Scholar
  35. 35.
    Iverson M, Hammond A, Betteridge N (2010) Self-management of rheumaotid diseases: state of the art and future perspectives. Ann Rheum Dis 69:955–963CrossRefGoogle Scholar
  36. 36.
    Bode C, Taal E, Emons P, Galezka M, Rasker J, Mart A et al (2008) Limited results of group self-management education for rheumatoid arthritis patients and their partners: explanations from the patient perspective. Clin Rheumatol 27:1523–1528PubMedCrossRefGoogle Scholar
  37. 37.
    U.S. Department of Health and Human Services (HHS). Healthy people 2010. http://www.healthypeople.gov/documents/HTML/Volume1/02Arthritis.htm. Accessed March 15, 2006.
  38. 38.
    Do B, Hootman J, Helmick C, Brady J (2011) Monitoring healthy people 2010 arthritis management objectives: education and clinician counseling for weight loss and exercise. Ann Fam Med 9:136–141PubMedCrossRefGoogle Scholar
  39. 39.
    Villacorta V, Kegeles S, Galea J, Konda KA, Cuba JP, Palacios CFC et al (2007) Innovative approaches to cohort retention in a community based HIV/STI prevention trial for socially marginalized Peruvian young adults. Clin Trials 4:32–41PubMedCrossRefGoogle Scholar
  40. 40.
    Stevens DP, Bowen JL, Johnson JK, Woods DM, Provost LP, Holman MR et al (2010) A multi-institutional quality improvement initiative to transform education for chronic illness care in resident continuity practices. J Gen Intern Med Suppl 4:574–580CrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2012

Authors and Affiliations

  • Doyt L. Conn
    • 1
  • Yi Pan
    • 2
  • Kirk A. Easley
    • 2
  • Dawn L. Comeau
    • 3
  • Joyce P. Carlone
    • 1
  • Steven D. Culler
    • 4
  • Athan Tiliakos
    • 1
  1. 1.Division of RheumatologyEmory University School of MedicineAtlantaUSA
  2. 2.Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaUSA
  3. 3.Department of Behavioral Sciences and Health Education, Rollins School of Public HealthEmory UniversityAtlantaUSA
  4. 4.Department of Health Policy and Management, Rollins School of Public HealthEmory UniversityAtlantaUSA

Personalised recommendations