The crisis in health care means many smaller centers are not enrolling patients with rheumatic diseases in drug programs, Prof. Brygida Kwiatkowska of the National Institute of Geriatrics, Rheumatology and Rehabilitation (NIGRiR) in Warsaw told PAP. In her assessment, the lack of proper treatment will cause these patients to die 10-15 years too early.
“We are witnessing a crisis in the Polish health care system at present; there is not enough money to meet the needs of all patients. As usual, the smallest centers will have the least chance of obtaining funds and covering the cost of treating patients under drug programs. This is clearly a threat to the health of Poles, because patients in different regions of the country will have no chance of good treatment,” Kwiatkowska, clinical director and head of the Early Arthritis Clinic at NIGRiR, told PAP. She added that differences in access to therapy between regions will deepen.
According to the rheumatologist, such disparities can already be observed, and a growing number of patients from other voivodeships (provinces) are coming to NIGRiR. Statistical data show that, compared with the previous year, significantly fewer patients with inflammatory rheumatic diseases are being enrolled in drug programs.
“There are currently a great many centers that have suspended qualifying patients for drug programs, and that have suspended hospitalizations and more expensive diagnostics. At our center, despite going into debt, we have not suspended qualification for therapy, and for now the Mazovian branch of the National Health Fund (NFZ) is paying for drugs used in the drug programs. We haven’t suspended it only because patients must be treated; it is what they are owed,” Kwiatkowska explained.
She stressed that drug programs in rheumatology are used by patients for whom standard therapies no longer work and who have nothing else to be treated with. “We must control the inflammation (many rheumatic diseases develop on an inflammatory basis – PAP), we must reach for further lines of treatment that guarantee the inflammatory process is kept in check, so that the patient does not writhe in pain,” said the rheumatology specialist.
She noted that the lack of proper treatment for patients with chronic inflammatory processes will shorten their lives by 10-15 years. “Because there is no control over the inflammatory process in the body, these patients will die from strokes, heart attacks and cancers, and they will also go on early disability pensions. Therefore, access to effective drugs for rheumatic patients should not be restricted; on the contrary, they should be used as prevention of serious health complications,” Kwiatkowska said.
She pointed out that patients will have to be treated anyway, but at a more advanced stage of the disease, which involves much higher costs and is far less effective.
Kwiatkowska noted that inflammatory rheumatic diseases are still diagnosed with great delay. Under the guidelines of scientific societies, no more than three months should pass between the onset of symptoms of an inflammatory rheumatic disease and the start of effective therapy. “Meanwhile, patients arrive after a year, two, three years, and before that they wander from specialist to specialist – family doctor, neurologist, orthopedist, rehabilitation specialist – and do not get a diagnosis. That also costs the system,” she explained. She pointed out that during this time patients develop irreversible organ damage that can no longer be reversed with drugs.
Kwiatkowska reminded listeners that the “Pilot Program for Comprehensive Care for Patients With Early Arthritis” (KOWZS for short), created on her initiative, is still operating. It is meant to shorten the diagnostic path for patients with early arthritis and ensure that they quickly receive effective treatment. “This project is intended for patients who have initial symptoms, such as pain or swelling of a joint or joints, but do not yet have a diagnosis. The aim is to catch them at a very early stage and shorten their path to a rheumatologist, which can be very long.
“KOWZS is meant to move patients with the most common inflammatory joint diseases, such as rheumatoid arthritis (RA) or spondyloarthropathies, from hospital care to well-organized outpatient care,” Kwiatkowska explained. She noted that those who should be hospitalized are patients with multi-organ complications, with vasculitis, and generally with severe rheumatic diseases, such as systemic lupus. Hospitalization is the most expensive option for the state – it means maintaining 24-hour duty rosters and physician and nursing staff. And keeping patients in the hospital who can be treated on an outpatient basis blocks access for other patients.
“Because KOWZS started with different delays at different centers, we asked the Ministry of Health to extend it,” Kwiatkowska said. She noted that patients diagnosed under KOWZS generally need prescription drugs, which are cheaper and more readily available than drugs financed under a drug program. “If in the first year a patient requires biologic treatment or other treatment under a drug program, the center that qualified the patient for KOWZS must guarantee that the patient gets into that drug program,” the rheumatologist pointed out. She also reminded listeners that the referral to the program is issued by a primary care physician (POZ).
The rheumatologist stressed that rheumatic diseases now affect 20 percent of Poland’s population. They include not only inflammatory rheumatic diseases but also degenerative joint disease and osteoporosis, which affects about 3 million people.
Joanna Morga (PAP)