Are All Routine Spondyloarthritis Outpatient Visits Considered Useful by Rheumatologists? An Exploratory Clinical Practice Study

Abstract

Objective: To determine (1) the proportion of routine spondyloarthritis (SpA) outpatient visits considered (un)necessary by rheumatologists, (2) characteristics of (un)necessary visits, and (3) whether previsit remote health outcome assessments can identify the necessity of ensuing visits.

Methods: A random sample of follow-up visits was evaluated at an SpA outpatient clinic. Before visits, patient-reported outcomes and disease activity were collected through an online health registry (SpA-Net). Rheumatologists were asked whether visits were considered necessary and whether therapy was altered. Clinical actions during visits were documented alongside demographic and clinical patient characteristics; these were compared for necessary vs unnecessary visits. Multivariable logistic regressions explored which previsit health outcomes (disease activity, patient-reported physical and mental health) were associated with the perceived necessity of visits. Predictive value was calculated for high disease activity thresholds of Ankylosing Spondylitis Disease Activity Score (ASDAS) and patient global assessment (PtGA).

Results: Of 114 outpatient visits, 39 (34.2%) were considered unnecessary. These visits involved fewer treatment changes (6 of 39 [15.4%] vs 39 of 75 [52.0%] visits) and clinical actions (9 of 39 [23.1%] vs 47 of 75 [62.7%] visits) compared to visits considered necessary. Previsit ASDAS (OR 4.06, 95% CI 1.80-9.17) and PtGA (OR 1.65, 95% CI 1.25-2.17) were associated with the perceived necessity of visits. Positive predictive value of ASDAS ≥ 2.1 and PtGA ≥ 3.0 were 91.7% and 80.0%, respectively.

Conclusion: Traditional physician-initiated follow-up for patients with SpA likely results in a suboptimal use of time and resources. Remote disease activity assessments can help identify patients for whom visits might be necessary from a rheumatologist's perspective.

Keywords: ambulatory care; outcome; psoriatic arthritis; spondyloarthritis.