Impact of patient-accessible electronic medical records in rheumatology: use, satisfaction and effects on empowerment among patients

Background To measure the use, satisfaction and impact of a web portal which provides patients with rheumatoid arthritis home access to their electronic medical records (EMR). Methods A pretest-posttest study was conducted among 360 patients. Questionnaires assessed socio-demographics, health literacy, Internet use, disease characteristics, patient-provider relationship and empowerment before and after launching a hospital-based patient web portal. To measure the impact of the portal, patients’ satisfaction with care, trust in their rheumatologist, self-efficacy in patient-provider communication, illness perceptions, and medication adherence were assessed. The post-test included questions on portal use, satisfaction, and self-perceived impact due to portal use. Results 54% of respondents with Internet access had viewed their EMR. Respondents were positive about the ease of use and usefulness of the portal and reported very few problems. Age (P = .03), amount of Internet use (P = .01) and self-perceived Internet skills (P = .03) significantly predicted portal use. Of the respondents who had logged in, 44% reported feeling more involved in their treatment and 37% felt they had more knowledge about their treatment. Significant differences over time were not found on the empowerment-related instruments. Conclusions The current portal succeeded in offering patients access to their EMR in a usable and understandable way. While its true impact is difficult to grasp, a relevant portion of the patients felt more involved in their treatment due to the web portal. Offering patients home EMR access, therefore, appears to be a valuable addition to the care proces

Intensive exercise therapy after hospitalization in patients with rheumatic diseases is more effective at limited extra costs: results from the DAPPER study

Purpose:\ud To estimate the cost utility and cost effectiveness of intensive exercise therapy (IET) compared to usual care (UC) in patients with Rheumatoid Arthritis (RA) and polyarticular Osteoarthritis (OA) recovering after hospitalization. \ud \ud Methods:\ud RA and OA patients (n = 114) who were admitted to the hospital because of active disease or for arthroplasty of hip or knee were randomly assigned to receive either a 3 week intensive training intervention directly following discharge in a dedicated convalescence institute or usual care. Quality adjusted life years (QALYs) were derived from the Short Form 6d (SF-6D) scores and visual analog scale (VAS) rating personal health. Outcome expressed as functional ability was calculated according to the Health Assessment Questionnaire (HAQ), the McMaster Toronto Arthritis Patient Preference Interview (MACTAR) and the Escola Paulista de Medicina - Range of Motion scale (EPM-ROM). Patients were followed for one year. Costs were reported from societal perspective. Differences in costs as well as Incremental Cost Effectiveness Ratios (ICERs) were estimated and 95% confidence intervals (CI) were calculated using double-sided bootstrapping.\ud \ud Results:\ud The data of 85 (50 intervention and 35 controls) of the 114 patients (75%) could be used for analysis. QALYs in both groups were similar according to the SF-6D but were in favour of IET according to the VAS-score personal health (6 month difference -1.05 QALYs; 95% CI -2.06 to -0.04). Functional ability was similar according to the HAQ, but in favour of the intensive training group according to the EPM-ROM (6 month difference 0.89; 95% CI 0.2 to 1.58) and MACTAR (6 month difference -6.0; 95% CI -10.3 to -0.5). After one year of follow-up no statistically significant differences between the groups were found. The increase per patient in total costs from societal perspective was estimated at € 804 (CI -€ 2,595 to € 3,996) after 6 months of follow-up. The resulting ICERs were € 8,398 per QALY according to the VAS-score (CI -€ 16,025 to € 23,032 per QALY); € 6,534 per EPM-ROM score point (CI -€ 9,996 to € 16,714) and € 799 per MACTAR point (CI -€ 2,432 to € 3,196).\ud \ud Conclusion:\ud After 6 months of follow-up IET was associated with slightly more costs and better effectiveness compared to UC. This underscores the general preference for intensive convalescence treatment over usual care for patients with rheumatic diseases recovering after hospitalization

Creating a Decision-Making Tool for Strategic Purchasing. A case study of SKF

The purchasing function has for the past decades been subject to forces shifting the internal strategic balance in its favor. Earlier having been seen as no more than a support function, the purchasing departments today carry a crucial role in realizing the overall corporate strategy. While organizations have adapted to the increased complexity of global sourcing, there still exist conceptual underdevelopment regarding how to decide the approach towards purchasing. Where the scope for supplier relationships ranges from short- to long-term, this thesis investigate an approach that falls in the middle - namely strategic purchasing. The purpose of this thesis was to develop a tool for organizations to evaluate characteristics of their purchases, which then would guide towards choosing the right purchasing approach. By doing a case study of SKF and conducting 21 semi-structured interviews, the thesis contributes in two major ways. First, the theoretical definition of strategic purchasing was compared to real-life practice, improving the concept’s empirical accuracy. Second, a multitheoretical approach was adopted to develop a framework identifying potential for strategic purchasing. The findings show how strategic purchasing deviates from theory in that a longterm focus can be achieved without committing to supplier relations. Further, the findings specify that Strategic Importance, Supply Complexity, Customization, Supply Market Volatility and Technological Uncertainty are five dimensions of characteristics that should be evaluated to provide guidance for the purchasing department. Last, a call for further research into the role of social capital as well as the measurability of the proposed framework is given.MSc in International Business and Trad

Sustained beneficial effects of a protocolized treat-to-target strategy in very early rheumatoid arthritis: three-year results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort

Objective\ud Treat-to-target (T2T) leads to improved clinical outcomes in early rheumatoid arthritis (RA). The question is whether these results sustain in the long term. Our objective was to investigate the 3-year results of a protocolized T2T strategy in daily clinical practice.\ud \ud Methods\ud In the Dutch Rheumatoid Arthritis Monitoring remission induction cohort, patients newly diagnosed with RA were treated according to a T2T strategy aimed at remission (Disease Activity Score in 28 joints [DAS28] <2.6). Patients were treated with methotrexate, followed by the addition of sulfasalazine, and exchange of sulfasalazine with anti–tumor necrosis factor α agents in case of failure. Primary outcomes were disease activity, Health Assessment Questionnaire (HAQ) score, Short Form 36 physical component summary (PCS) and mental component summary (MCS) scores, and the Sharp/van der Heijde score (SHS) after 3 years. Secondary outcomes were sustained DAS28 remission (≥6 months) and remission according to the provisional American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) definition.\ud \ud Results\ud After 3 years (n = 342), 61.7% of patients were in DAS28 remission and 25.3% met the provisional ACR/EULAR definition of remission. Sustained remission was experienced by 70.5%, which in the majority was achieved with conventional disease-modifying antirheumatic drugs only. The median scores were 0.4 (interquartile range [IQR] 0.0–1.0) for the HAQ, 45.0 (IQR 38.4–53.2) for the PCS, 53.1 (IQR 43.2–60.8) for the MCS, and 6.0 (IQR 3.0–13.0) for the total SHS.\ud \ud Conclusion\ud In very early RA, T2T leads to high (sustained) remission rates, improved physical function and health-related quality of life, and limited radiographic damage after 3 years in daily clinical practice