A Case Management Model for Patients with Granulomatous Mastitis: A Prospective Study

Background: Granulomatous mastitis is a chronic inflammatory mastitis disease with long-term treatment and high recurrence rate, there is no general agreement on effective clinical management, the new management model is worthy of investigation. The aim of this study to investigate the application of case management model in granulomatous mastitis and explore the related factors which are associated with the recurrence of granulomatous mastitis. Methods: This is a prospective study of 152 Chinese women who were monitored during the whole process of case management. Demographic, clinical and laboratory information, treatment methods, follow-up time, and recurrence were collected and analyzed. The eight-item Morisky medication adherence scale (MMAS-8) was used to investigate patients' adherence to medications. Results: Until October 2021, a total of 152 female patients with a mean age of 32 years have received the entire process of case management. The mean total course of case management was 24.54 (range, 15 - 45) months. Almost all the patients received medication treatment, except for one pregnant patient on observation therapy, and about 53.9% of the patients had medication plus surgery. The overall recurrence rate was 11.2%, and “high” medication adherence (RR=0.428, 95% CI: 0.224-0.867, P = 0.015) were significantly associated with a lower rate of recurrence while the rate of recurrence with surgical procedure + medication was higher than that with medication treatment (RR = 4.128, 95% CI: 1.026 - 16.610, P = 0.046). Conclusion: case management model for patients with granulomatous mastitis was effective with a relatively low recurrence rate. “Low” medication adherence were significant risk factors for the recurrence of granulomatous mastitis. Patients with medication plus surgery are more likely to recur than with medication treatment alone. The optimal treatment approach should be planned for GM patient and patient’s medication adherence should be of concern to medical staff.