Gaps in care for rheumatoid arthritis: A population study

Abstract

Objective. Treatment guidelines for rheumatoid arthritis (RA) now recommend early, aggressive, and persistent use of disease-modifying antirheumatic drugs (DMARDs) to prevent joint damage in all people with active inflammation, and evaluation by a rheumatologist, when possible. This research assesses whether care for RA, at a population level, is consistent with current treatment guidelines. Methods. Using administrative billing data from the Ministry of Health in 1996 -2000, all prevalent RA cases in British Columbia, Canada were identified. Data were obtained on all medications and all provincially-funded health care services. Results. We identified 27,710 RA cases, yielding a prevalence rate of 0.76%, consistent with epidemiologic studies. DMARD use was inappropriately low. Only 43% of the entire RA cohort received a DMARD at least once over 5 years, and 35% over 2 years. When used, DMARDs were started in a timely fashion, but were not used consistently. Care by a rheumatologist increased DMARD use 31-fold. Yet, only 48% and 34% saw a rheumatologist over 5 and 2 years, respectively. DMARD use was significantly more frequent, persistent, and more often used as combination therapy with continuous rheumatologist care. DMARDs were used by 84% and 73%, 40%, and 10% of people followed by rheumatologists continuously and intermittently, internists, and family physicians, respectively (P < 0.001). NSAID use, physiotherapy, and orthopedic surgeries were similar across these 4 care groups. Conclusion. RA care in the British Columbia population was not consistent with current treatment guidelines. Efforts to educate family physicians and consumers about the shift in RA treatment paradigms and to improve access to rheumatologists are needed.

Anti–tumor necrosis factor α therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis

“…We observed a high proportion of patients identified as having RA that were treated with glucocorticoids only. While this patient group could be contaminated by some patients who have osteoarthritis that was misclassified as RA, it is compatible with treatment patterns of RA observed in population-based studies outside of academic centers (38).…”

Incidence of Rheumatoid Arthritis in Sweden: A Nationwide Population‐Based Assessment of Incidence, Its Determinants, and Treatment Penetration

“…However, the registerbased approach may be associated with other limitations, such as being sensitive to the definition of incident RA. Indeed, case ascertainment in register-based prevalence and incidence assessments generally pertains to physiciandiagnosed/-treated RA (5,6,8,13,14), which may not necessarily be fully congruent with the American College of Rheumatology (ACR) (15) or the ACR/European League Against Rheumatism (EULAR) (16) criteria for RA. On the other hand, the register-based approach may be more reflective of RA incidence as perceived by the health care system.…”

Utilization of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Systemic Lupus Erythematosus Patients: A 13‐Year Population Health Study

“…First, due to the homogenous nature of the Nova Scotia population, it was not possible to examine the effect of race and ethnicity on health care utilization. Second, although the definition of incident cases was in agreement with traditional methodology in population health studies (12), it would not have excluded SLE patients with longstanding disease who relocated to Nova Scotia during the period of study. Third, the range in the proportion of female patients, between 78.0% and 85.1%, across case definitions is lower than the 90% seen in most lupus cohorts, although these are usually drawn from subspecialty clinics and inpatient units in health care facilities.…”

“…This excludes First Nation Canadians and members of the Canadian armed forces. Incident cases of SLE were defined as those without a physician billing for the same diagnosis in the preceding 5 years (12). Prevalent cases included both incident and nonincident cases.…”