The following is a summary of “Are All Routine Spondyloarthritis Outpatient Visits Considered Useful by Rheumatologists? An Exploratory Clinical Practice Study” published in the November 2022 issue of Rheumatology by Hermans, et al.
The goals of this study are to (1) identify the percentage of routine spondyloarthritis (SpA) outpatient visits that rheumatologists consider (un)necessary, (2) characterize (un)necessary visits, and (3) evaluate whether remote health outcome assessments performed before visits can identify the necessity of subsequent visits. In addition, an evaluation of a subset of follow-up visits to a clinic for people with SpA was conducted. Disease activity and outcomes were recorded from patients in advance of their appointments using an online health registry (SpA-Net).
The question was posed to rheumatologists as to whether they felt it was necessary to change the course of treatment or if further visits were not required. Patients’ demographic and clinical features and their clinical activities during visits were recorded and compared to determine whether or not the visits were essential. Which previsit health outcomes (disease activity, patient-reported physical and mental health) were connected with the felt need for visits and were investigated using multivariable logistic regressions. Ankylosing spondylitis disease activity score (ASDAS) and patient global evaluation predictive value for high disease activity thresholds (PtGA). From a total of 114 outpatient appointments, 39 (41.7%) were deemed unnecessary.
Treatment adjustments were made at a lower rate (6 out of 39, or 15.4 %), and fewer clinical interventions were taken (9 out of 39, or 23.1 %) compared to visits deemed required (47 out of 75, or 62.7%). The perceived necessity of visits was linked to both previsit ASDAS (OR 4.06, 95% CI 1.80-9.17) and PtGA (OR 1.65, 95% CI 1.25-2.20). ASDAS ≥2.1 had a 91.7% positive predictive value, and PtGA ≥3.0 had an 80.0% positive predictive value. Follow-up care for patients with SpA that is traditionally initiated by doctors is probably inefficient. Rheumatologists can benefit from remote disease activity assessments by learning which patients may benefit from in-person contact.