Evaluation of the mediator role of treatment adherence and severity of illness in the effect of continuity of care on treatment outcomes and cost of illness: A study on rheumatoid arthritis patients

In this study, it was aimed to evaluate the effect of continuity of care on treatment outcomes [health outcomes (quality of life, functionality level and disability) and treatment effectiveness] and cost of illness (from both third-party payer and patient perspective) in patients with rheumatoid arthritis and to reveal whether treatment adherence and severity of illness have serial multiple mediating roles on this relationship. The population of the study consists of 1306 rheumatoid arthritis patients who applied to Hacettepe University Adult Hospital Rheumatology Clinic and the sample size to be reached within the scope of the research was decided to be 440 with the help of the formula used for the groups with known population. The data in the study were obtained from both the primary data source, the survey method, and the secondary data source, patient files and invoices. In the analysis of the data, validity (confirmatory factor analysis) and reliability (test-retest and Cronbach's Alpha) analyzes as well as multiple linear regression analysis and process analysis were used. According to the analysis made; It was found that the scales were valid and reliable and that continuity of care had a direct effect on overall health outcomes, treatment effectiveness and cost of illness. In addition, it is seen that treatment adherence and severity of illness have a single partial mediating role on the relationship between continuity of care and quality of life, working time lost due to illness, and treatment effectiveness, while it has been determined that treatment adherence and severity of illness have both partial single mediation and serial multiple mediation roles on the relationship between continuity of care and functionality, reduced work efficiency due to illness, and cost of illness. These findings are thought to provide important data and information to clinicians in the management of rheumatoid arthritis.