Treatment of older adult patients diagnosed with rheumatoid arthritis: Improved but not optimal

Gabriela Schmajuk, Sebastian Schneeweiss, Jeffrey N. Katz, Michael E. Weinblatt, Soko Setoguchi, Jerry Avorn, Raisa Levin, Daniel H. Solomon

Research output: Contribution to journalArticlepeer-review

88 Scopus citations

Abstract

Objective. The National Committee on Quality Assurance has determined that all patients with rheumatoid arthritis (RA) should be treated with disease-modifying antirheumatic drugs (DMARDs). Our objective was to determine the rate and predictors of DMARD use in a cohort of elderly patients with RA. Methods. We analyzed health care utilization data for 5,864 Medicare beneficiaries with RA who also participated in a state-run pharmaceutical benefit program in Pennsylvania. Patients with RA were defined as those with at least 3 diagnoses of RA (International Classification of Diseases, Ninth Revision code 714.xx) at least 1 week apart who were enrolled in these programs for at least 12 months during 1995-2004. Multivariate logistic regression was used to assess predictors of synthetic or biologic DMARD use in the 12 months after cohort entry. Results. Thirty percent of patients filled a DMARD prescription during 12 months of followup. Frequency of DMARD use increased steadily over time: 24% received DMARDs in 1996 compared with 43% in 2003 (P for trend <0.001). Of patients with at least 1 rheumatologist visit, 41% received a DMARD in 1996 compared with 70% in 2003 (P < 0.001). After the introduction of biologic DMARDs in 1998, 6% of all patients with RA received a biologic, including 12% who saw a rheumatologist. Patients ages 75-84 were 52% less likely to receive DMARDs (95% confidence interval [95% CI] 46-58%) and patients ages ≥85 were 74% less likely (95% CI 69-79%) compared with patients ages 65-74. Conclusion. In this cohort of patients in the community with full prescription drug coverage, most patients diagnosed with RA did not receive a DMARD during the 12 months after cohort entry. Older patients and those not seeing a rheumatologist were less likely to receive a DMARD and may provide a target for quality improvement interventions.

Original languageEnglish (US)
Pages (from-to)928-934
Number of pages7
JournalArthritis Care and Research
Volume57
Issue number6
DOIs
StatePublished - Aug 15 2007
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Rheumatology

Keywords

  • Access to care
  • DMARDs
  • Drug utilization
  • Health services research
  • Rheumatoid arthritis

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