Fernando Perez-Ruiz, Cristina Vazquez-Puente, Maria Del Consuelo Modesto- Caballero, Ana María Herrero-Beites
Affiliation(s):
Rheumatology Division, Cruces University Hospital
Background: adherence to treatment has been widely studied, but not adherence to follow-up visits. Objective: to analyze factors associated to loss for follow-up in patients with gout and with a programmed follow-up visit to the rheumatology office. Method: analysis of data from an inception cohort of patients with gout prospectively followed-up in a university hospital setting. Variables include general data, along with clinical characteristics of gout, comorbidities, treatment and adherence to prescribed urate-lowering therapy (ULT). Those variables associated (p<0.20) in bivariate analysis were included in a multivariate analysis. Patients who did not attend to a visit because they passed were not considered as lost for follow-up.
Results: from a series of 1,442 consecutive patients, 354 (24.5%) were lost for follow-up; 219 (15.2%) did not attended because they died between programmed visits. Mean follow-up until lost for follow-up was 32 months vs. 49 months for patients who still remained in active follow-up. Age (older), gender (women), pooled comorbidity (higher), severity of gout (monoarticular), alcohol intake (<15 g/day), adherence (MPR> 80%), previous treatment (none), and consultation (primary care), were associated to higher rates of loss for follow-up in bivariate analysis. No association was found between persistence on follow-up and time from onset of gout, presence of tophi, number of flares per year, previous and prescribed ULT. In multivariate analysis (Table), only higher age, higher adherence to prescribed, and consultation from primary care were independently associated to persistence on follow-up. Severity of gout (polyarticular disease) seemed to be also associated to persistence, but lacked statistical significance. Table 1. Multivariate analysis of factors associated to loss for follow-up. B Sig. Exp(B) 95% C.I.L. for EXP(B) Lower Upper Age -,029 ,001 ,972 ,955 ,989 Primary care on -1,651 ,008 ,192 ,057 ,647 Adherence -1,120 ,000 ,326 ,186 ,572 Polyarticular) -,358 ,107 ,699 ,416 ,1,17 Comorbidity(3-4) ,199 ,519 1,220 ,666 2,234 No previous ULT -,196 ,477 1,217 ,709 2,089 Gender (male) ,256 ,566 1,292 ,539 ,988 Ethanol>15g/day ,005 ,987 ,995 ,543 1,823.
Conclusion: in our clinical setting, the profile of patients at higher risk of abandoning prescribed follow-up is that of a younger, poorly adherent, with lower burden of disease, and consulting through an assistance “short-cut” (other than primary care).