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Shared decision-making for biologic treatment of autoimmune disease: influence on adherence, persistence, satisfaction, and health care costs

机译：自身免疫性疾病生物治疗的共同决策：对依从性，持久性，满意度和医疗保健费用的影响

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Background: Shared decision-making (SDM), a process whereby physicians and patients collaborate to select interventions, is not well understood for biologic treatment of autoimmune conditions. Methods: This was a cross-sectional survey of adults initiating treatment for Crohn’s disease or ulcerative colitis (inflammatory bowel disease, IBD) or psoriatic arthritis or rheumatoid arthritis (RAPA). Survey data were linked to administrative claims for 6?months before (baseline) and after (follow-up) therapy initiation. Measures included the Shared Decision Making Questionnaire, Patient Activation Measure (PAM), Morisky Medication Adherence Scale (MMAS), general health, and treatment satisfaction. Claims-based Quan–Charlson comorbidity scores, persistence, medication possession ratio (MPR), and health care costs were examined. Patients were compared by participation (SDM) and nonparticipation (non-SDM) in SDM. Results: Among 453 respondents, 357 were eligible, and 306 patients (204 RAPA and 102 IBD) were included in all analyses. Overall (n=357), SDM participants (n=120) were more often females (75.0% vs 62.5%, P =0.018), had lower health status (48.0 vs 55.4, P =0.005), and higher Quan–Charlson scores (1.0 vs 0.7, P =0.035) than non-SDM (n=237) participants. Lower MMAS scores (SDM 0.17 vs non-SDM 0.41; P <0.05) indicated greater likelihood of adherence; SDM participants also reported higher satisfaction with medication and had greater activation (PAM SDM vs non-SDM 66.9 vs 61.6; P <0.001). Mean MPR did not differ, but persistence was longer among SDM participants (111.2?days vs 102.2?days for non-SDM; P =0.029). Costs did not differ by SDM status overall, or among patients with RAPA. The patients with IBD, however, experienced lower ( P =0.003) total costs ($9,404 for SDM vs $25,071 for non-SDM) during follow-up. Conclusion: This study showed greater likelihood of adherence and satisfaction for patients who engaged in SDM and reduced health care costs among patients with IBD who engaged in SDM. This study provides a basis for defining SDM participation and detecting differences by SDM participation for biologic treatment selection for autoimmune conditions.
机译：背景：对于自身免疫性疾病的生物学治疗，医生和患者合作选择干预措施的过程尚未被广泛理解。方法：这是一项针对成年人开始接受克罗恩病或溃疡性结肠炎（炎症性肠病，IBD）或银屑病关节炎或类风湿关节炎（RAPA）治疗的横断面调查。调查数据与开始治疗前（基线）和术后（随访）6个月的行政要求相关。措施包括共享决策调查表，患者激活措施（PAM），Morisky药物依从性量表（MMAS），总体健康状况和治疗满意度。基于索赔的Quan-Charlson合并症评分，持续性，药物拥有率（MPR）和医疗保健费用进行了检查。通过参与（SDM）和不参与（non-SDM）对患者进行比较。结果：在453位受访者中，有357位符合条件，所有分析中包括306位患者（204位RAPA和102位IBD）。总体而言（n = 357），SDM参与者（n = 120）的女性更多（75.0％对62.5％，P = 0.018），健康状况较低（48.0对55.4，P = 0.005）和Quan-Charlson评分较高（1.0 vs 0.7，P = 0.035）比非SDM（n = 237）参与者高。较低的MMAS评分（SDM为0.17，非SDM为0.41; P <0.05）表明遵守的可能性更高; SDM参与者还报告了对药物的更高满意度和更高的激活率（PAM SDM与非SDM 66.9与61.6; P <0.001）。平均MPR没有差异，但SDM参与者的持久性更长（111.2天，而非SDM为102.2天; P = 0.029）。总体而言，费用在SDM状态或RAPA患者之间没有差异。然而，在随访期间，IBD患者的总费用较低（P = 0.003）（SDM为9,404美元，非SDM为25,071美元）。结论：这项研究表明，从事SDM的患者有更大的依从性和满意度，并降低了从事SDM的IBD患者的医疗保健费用。这项研究为定义SDM参与和通过SDM参与检测自身免疫疾病的生物治疗选择提供了基础。

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