Are rheumatologists' treatment decisions influenced by patients' age?

Fraenkel, Liana; Rabidou, Nicole; Dhar, Ravi

doi:10.1093/rheumatology/kel144

Cited by 65 publications

(67 citation statements)

References 25 publications

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“…Another factor leading to less aggressive treatment in older RA patients may be physician preference. 34 We also observed that patients in the South were more likely to initiate treatment with TNF-α inhibitors. Ours is the first study to document regional variations in the initiation of treatment with TNF-α inhibitors.…”

Section: Limitationsmentioning

confidence: 54%

Predictors of Treatment Initiation with Tumor Necrosis Factor-α Inhibitors in Patients with Rheumatoid Arthritis

Desai¹,

Rao²,

Hansen³

et al. 2014

JMCP

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Section: Limitationsmentioning

confidence: 54%

Predictors of Treatment Initiation with Tumor Necrosis Factor-α Inhibitors in Patients with Rheumatoid Arthritis

Desai¹,

Rao²,

Hansen³

et al. 2014

JMCP

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“…Thirteen studies focussed on cardiac conditions, of which ten specifically explored medication underutilisation in atrial fibrillation. Four studies investigated the influence of patient age on clinicians' treatment decisions (Hajjar et al, 2002;Fraenkel et al, 2006;Harries et al, 2007;Kievit et al, 2010).…”

Section: Number and Type Of Studiesmentioning

confidence: 99%

“…Studies investigating clinicians' understanding of 'old age' have focused on the management of rheumatoid arthritis (Fraenkel et al, 2006;Kievit et al, 2010), angina (Harries et al, 2007), and hypertension (Hajjar et al, 2002). Studies have revealed health professionals' biased understanding of 'old age' (Hajjar et al, 2002;Fraenkel et al, 2006;Harries et al, 2007), and that some physicians regard 'old age' a contraindication to treatment (Harries et al, 2007).…”

Section: Clinicians' Understanding Of 'Old' Agementioning

confidence: 99%

“…Studies have revealed health professionals' biased understanding of 'old age' (Hajjar et al, 2002;Fraenkel et al, 2006;Harries et al, 2007), and that some physicians regard 'old age' a contraindication to treatment (Harries et al, 2007). Their understanding of diseases and subsequent treatment choices change with increasing patient age (Hajjar et al, 2002).…”

Section: Clinicians' Understanding Of 'Old' Agementioning

confidence: 99%

“…Their understanding of diseases and subsequent treatment choices change with increasing patient age (Hajjar et al, 2002). Clinicians are also reportedly reluctant to use aggressive treatment measures in older patients (Fraenkel et al, 2006;Kievit et al, 2010), for instance, rheumatologists are reluctant to escalate care in patients aged 80 years or above (Kievit et al, 2010).…”

Section: Clinicians' Understanding Of 'Old' Agementioning

confidence: 99%

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Pharmacotherapy in the ageing patient: The impact of age per se (A review)

Singh

Bajorek

2015

Ageing Research Reviews

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A literature search was carried out to review the influence of 'ageing' on pharmacotherapeutic decision-making, specifically how 'age' is defined and considered in the utilisation of medication. Embase, Medline, International Pharmaceutical Abstracts, and Google scholar were canvassed in a three-tiered search according to pre-established inclusion criteria. In tier 1, a total of 22 studies were identified highlighting the underutilisation of medication in elderly patients, with a particular focus on warfarin. Four studies highlighted an age-bias in medication-prescribing for elderly patients, specifically in relation to medicines for rheumatoid arthritis, angina, and hypertension. Tier 2 identified diverse definitions for 'elderly', including biological age, chronological age, physiological age, as well as various descriptions of 'elderly' in clinical trials and guidelines. Finally, medication optimisation tools were identified through the third tier, emphasising the use of chronological age to describe the 'elderly'. Old age influences pharmacotherapeutic decision-making at various levels, however, what complicates the situation is the absence of a comprehensive definition of 'elderly'. Clinical recommendations need to be based more on objective factors known to affect medication effectiveness and safety.

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Physician preference motivates the use of anti–tumor necrosis factor therapy independent of clinical disease activity

Curtis¹,

Chen²,

Harrold³

et al. 2009

Arthritis Care & Research

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Objective. Physician preference has previously been shown to be an important determinant of prescription patterns, independent of patient-specific factors. We evaluated whether physician preference was important in the decision to select anti-tumor necrosis factor (anti-TNF) therapy rather than nonbiologic disease-modifying antirheumatic drugs (DMARDs) among rheumatoid arthritis (RA) patients initiating a new RA medication. Methods. Using data from the Consortium of Rheumatology Researchers of North America, we identified RA patients who had never taken biologics initiating either anti-TNF therapy or a DMARD in 2001-2008. Physician preference for the use of anti-TNF agents was calculated using data from the preceding calendar year for each physician's other RA patients. Multivariable logistic regression with generalized estimating equations accounted for clustering of patients within the physician practice and evaluated the relationship between physician preference and receipt of anti-TNF therapy, controlling for patient-related factors and disease activity using the Clinical Disease Activity Index. Results. We identified 1,532 RA patients initiating anti-TNF therapy or a DMARD. In models adjusting for tender and swollen joint counts and global disease activity, physician preference for the use of anti-TNF therapy was an independent predictor of receipt of these agents. Patients of physicians in the highest and middle tertiles of physician preference had a 2.50 (95% confidence interval [95% CI] 1.76 -3.56) and 1.70 (95% CI 1.22-2.39) greater likelihood of receiving anti-TNF medications, respectively. Conclusion. Physician preference is an important determinant of patients' receipt of anti-TNF therapy and may be useful to examine in future studies of RA treatment patterns, costs, and medication safety.

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Are rheumatologists' treatment decisions influenced by patients' age?

Abstract: Our findings suggest that rheumatologists' treatment recommendations may be influenced by age. Future educational efforts should increase physician awareness of this possible bias in order to ensure equal service delivery across ages.

Cited by 65 publications

References 25 publications

Predictors of Treatment Initiation with Tumor Necrosis Factor-α Inhibitors in Patients with Rheumatoid Arthritis

Predictors of Treatment Initiation with Tumor Necrosis Factor-α Inhibitors in Patients with Rheumatoid Arthritis

Pharmacotherapy in the ageing patient: The impact of age per se (A review)

Physician preference motivates the use of anti–tumor necrosis factor therapy independent of clinical disease activity

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