Control of rheumatoid arthritis at rheumatology outpatient department of Universitas Hospital, Bloemfontein

Abstract

Background: Rheumatoid arthritis is a highly prevalent disease with a significant negative impact on morbidity and life expectancy. There is a paucity of literature relating to the current state of disease control in South Africa, and none so in the Free State province. Objectives: 1. To evaluate the degree of control of rheumatoid arthritis at the Rheumatology outpatient department of Universitas Central Hospital. 2. To determine the relative impact of various factors contributing to the prevention of disease control. Methods: A cross sectional study was undertaken over a period of 8 months from December 2016 to August 2017 at the Rheumatology outpatient department of Universitas Central Hospital in Bloemfontein. Data were collected by means of information sheets completed by treating physicians. The information obtained was related to the current disease state, possible reasons for poor control, and relevant demographic data. Results: Information was collected from 169 participants and data analysis was performed on 161 of these patients. The results revealed that 34 (21.12%) patients were controlled. Of the 127 patients not controlling, 61 (37.89%) reported dispensing issues related to poor drug availability, and 72 (56.69%) were on insufficient treatment for their disease state. In 69.29% of these patients, however, concomitant dispensing issues were reported. Other factors such as transport/access problems, administrative issues, adverse events, and poor compliance/insight played minor roles. In terms of monthly dispensing: 95.65% of patients reported to have received all of their Disease Modifying Anti-Rheumatic Drugs (DMARDs) during the first month (the vast majority of which were dispensed from Universitas Hospital). This reduced to 73.91% during the second month (mostly from district units) and only 55.26% reported receiving all of their DMARDs from their down referral units. Conclusions: The disease control in this institution is suboptimal when comparing to local and international standards. The main contributors to poor control seem to be problems related to dispensing of medication as well as inadequate escalation of therapy by doctors. The bulk of concern with the dispensing of medication lies with the poor availability of DMARDs in peripheral unit pharmacies. These are remediable factors which should be attended to.