Gaps in Rheumatology Care for People With Rheumatoid Arthritis
โ If continuity of care drops when healthcare is free, what happens to patients with private payors?
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As I read through the study by Barber and colleagues in -- which set off to identify gaps in care continuity for patients with RA specific for the Ontario province in Canada -- I tried to compare their findings with the general body of knowledge and my personal (and colleagues') experience.
The multi-variate analysis linked older age, male gender, lower socioeconomic status, higher comorbidity scores, and distance from the rheumatologist location as factors associated with attrition of follow-up. All those factors were known and matched what we generally observe in our own practices: male patients, older age, driving distance and lower means could all contribute to skipping chronic medical follow up, especially if one could get a prescription without being seen.
The authors found the gender of the rheumatologist (favoring female) contributing to patient retention in univariate analysis, but not in multivariate analyses. Could it be that women rheumatologists, proverbially branded as spending more time with each patient, translate that extra time they spend with the patient into longer retention? I am not sure the rheumatologists' age finding is generalizable but indeed cutting down on busy practice, retiring and taking more consultancy roles could all explain that trend. While we grow more efficient with age, continuous adaptation to electronic medical records and meeting "healthcare metrics" could also turn a lot of our older colleagues away from seeing patients.
What I find interesting in this study in which healthcare and drugs were free (for individuals over 65 years of age), is the continuity of care is still declining at five years. Is it the same in patients with a variety of private payors? Rheumatological conditions require chronic, often lifetime follow-up and tweaking of treatment for good outcomes. While ultimately an individual patient choice, rheumatologists (with the help of clinic administrators) should analyze factors that improve long term retention.
Elena Schiopu, MD, is Professor of Medicine at the Medical College of Georgia at Augusta University.
Read the study here and a Q&A with the study's first author here.
Primary Source
ACR Open Rheumatology
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