Care quality for rheumatoid arthritis patients in Quebec

Int J Rheum Dis. 2019 Jul;22(7):1233-1238. doi: 10.1111/1756-185X.13580. Epub 2019 Apr 16.


Aim: The aims of this study were to: (a) measure the proportion of CARTaGENE rheumatoid arthritis (RA) patients fulfilling pre-specified quality indicators (ie disease-modifying antirheumatic drug [DMARD] use, regular follow up, use of folate supplementation, use of vitamin D and calcium, exercise and smoking status); and (b) examine variation in DMARD use with respect to patient age, sex, education and income.

Methods: A cohort of RA patients was constructed based on the CARTaGENE survey and health administrative database. CARTaGENE is a large, established, population-based study which recruited 19 995 participants from four metropolitan regions in Quebec. Six quality indicators (QI) were assessed; four pertained to RA management and treatment received (use of DMARD therapy, annual medical visits, use of folate supplementation with methotrexate therapy, and use of calcium and vitamin D in steroid-exposed patients) and two pertained to lifestyle factors (physical activity and smoking cessation). QI were reported in terms of proportion of patients fulfilling them. Bayesian logistic regression analyses were preformed to investigate potential variation with DMARD use.

Results: Our cohort included 142 RA patients. The QI that pertain to RA pharmacotherapy and medical management ranged 60-80%. Regarding the QI focusing on lifestyle factors, 55% of patients reported performing moderate physical activity and only 16.6% reported current smoking. Results from the Bayesian logistic regression showed no definite associations between DMARD use and patient characteristics (age, education, income and sex).

Conclusion: Our findings suggest a seemingly modest performance of Quebec's health-care system for RA patients, with respect to these QI.

Keywords: CARTaGENE; Régie de l’assurance maladie du Québec; disease-modifying antirheumatic drug; quality of care; rheumatoid arthritis; self-reported survey.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / diagnosis
  • Arthritis, Rheumatoid / therapy*
  • Databases, Factual
  • Dietary Supplements*
  • Educational Status
  • Exercise
  • Female
  • Health Care Surveys
  • Humans
  • Income
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care / standards*
  • Practice Patterns, Physicians' / standards*
  • Quality Indicators, Health Care / standards*
  • Quebec
  • Rheumatology / standards*
  • Risk Reduction Behavior*
  • Sex Factors
  • Smoking Cessation
  • Treatment Outcome


  • Antirheumatic Agents