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Changes in Treatments and Outcomes After Implementation of a National Universal Access Program for Juvenile
Sara Concha1, Pamela S Morales1, Eduardo Talesnik1
1S. Concha, MD, P.S. Morales, MD, E. Talesnik, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile.
Insights
Chile's Explicit Health Guarantees (GES) improved juvenile idiopathic arthritis (JIA) care by speeding diagnosis and increasing biologic drug use, leading to better remission rates and fewer uveitis complications in children with JIA.
Area of Science:
- Pediatric Rheumatology
- Public Health Policy
- Clinical Outcomes Research
Background:
- Juvenile idiopathic arthritis (JIA) is a significant pediatric rheumatic disease.
- Chile implemented the Explicit Health Guarantees (GES) in 2010 for universal access to JIA diagnosis and treatment.
- Evaluating the impact of national health policies on pediatric rheumatology care is crucial.
Purpose of the Study:
- To assess clinical and demographic features of Chilean JIA patients.
- To compare JIA treatments and outcomes before and after the 2010 GES implementation.
- To determine the effectiveness of a national universal access program on JIA management.
Main Methods:
- Retrospective review of clinical records for 280 JIA patients (2007-2018).
- Analysis of patient demographics, diagnostic timelines, treatment modalities, and clinical outcomes.
- Comparison of data pre- and post-GES implementation.
Main Results:
- Post-GES, time to pediatric rheumatologist evaluation and diagnostic delay significantly decreased (P=0.004).
- Biologic drug use increased significantly post-GES (34% of pre-GES diagnosed patients, 46% of post-GES diagnosed patients).
- JIA remission rates were higher (43% vs 29%, P=0.02) and uveitis complications lower (13% vs 45%, P=0.04) post-GES.
Conclusions:
- The GES program facilitated earlier JIA diagnosis and rheumatologist access in Chile.
- National policy led to increased use of biologic therapies and improved clinical remission rates.
- GES implementation resulted in reduced uveitis complications among pediatric JIA patients.
Objective:
To evaluate the clinical and demographic characteristics of patients with juvenile idiopathic arthritis (JIA) in Chile and compare treatments and outcomes before and after the introduction in 2010 of the Explicit Health Guarantees (GES) for JIA, a national universal access program for diagnosis and treatment of this condition.
Methods:
The clinical records of 280 patients with JIA followed at a private tertiary academic health network between 2007 and 2018 were reviewed.
Results:
Seventy percent of patients with JIA were female, mean age at diagnosis was 8.5 ± 4.8 years and mean follow-up was 4.0 ± 3.7 years. After GES implementation (post-GES), time to evaluation by pediatric rheumatologist and diagnostic delay were significantly reduced (15.0 ± 4.5 vs 9.0 ± 4.2 months, P = 0.004). In addition, use of magnetic resonance imaging significantly increased post-GES (P < 0.001). In terms of JIA treatments, before GES implementation, no patients received biologics. Of the 67 patients diagnosed before 2010 with continued follow-up at our center, 34% began biologic treatment after GES implementation. Of 196 patients diagnosed post-GES, 46% were treated with biologics. JIA remission rates were significantly higher in patients diagnosed post-GES compared to pre-GES (43% vs 29%, P = 0.02). Post-GES, we observed a significant decrease in uveitis complications among JIA patients (45% vs 13%, P = 0.04).
Conclusion:
The implementation of a national government-mandated universal access program for guaranteed JIA diagnosis and treatment led to earlier access to a pediatric rheumatologist and JIA diagnosis, increased rates of treatment with biologic drugs, higher rates of clinical remission, and lower rates of uveitis complications in Chilean children with JIA.
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