[Influence of the treatment setting on the treatment of patients with rheumatoid arthritis or psoriatic arthritis within the delegation to rheumatological specialist assistants - A post hoc analysis of the StärkeR study].

Abstract

Background: The StärkeR study has shown the non-inferiority of a team-based form of care with delegation to rheumatological specialist assistants (RFA) compared to standard care in patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA).

Objective: Exploratory analyses regarding a possible influence of the treatment setting (specialist practice/outpatient clinic) on various outcome parameters in patients with RA or PsA in the context of delegation to RFA.

Material and methods: Patients with RA or PsA and stable adjustment with low disease activity from 3 outpatient clinics and 14 rheumatological specialist practices that participated in the StärkeR study were included in this post hoc analysis. The effectiveness of the team-based form of care depending on the treatment setting was investigated using interaction analyses in linear regression models with respect to disease activity, functional capacity, pain and fatigue, among others.

Results: Out of 588 patients 466 were treated in specialized practices and 92 in hospital outpatient clinics. The analyses showed a significant interaction for one of nine outcomes examined: functional capacity (scale 0-1) had slightly lower values in the hospital outpatient clinics compared to standard care (-0.07 [-0.12; -0.02]), while no such difference was found in the practices. For other outcomes, the team-based form of care in the practice setting tended to show an advantage.

Discussion: These exploratory analyses point to the potential benefits of evaluating different forms of care, such as the delegation of medical services to qualified RFA, in terms of benchmarking.