Study Finds
Treatment of Senior Citizens with Rheumatoid Arthritis is Unacceptable
Wide variations
found in Medicare Managed Care patients receipt of recommended drug
therapy
Feb. 1, 2011 - An
analysis of data from more than 90,000 Medicare managed care enrollees
who received care for rheumatoid arthritis finds that more than
one-third did not receive the recommended treatment with a
disease-modifying anti-rheumatic drug, and that receipt varied by
demographic factors, socio-economic status, geographic location and
health plan, according to a study in the February 2 issue of the Journal
of the American Medical Association (JAMA).
Despite
evidence-based guidelines recommending early and aggressive treatment of
active rheumatoid arthritis (RA), recent based studies of
disease-modifying anti-rheumatic drug (DMARD) receipt in patients with
RA report low rates of use, although these data may not be broadly
generalizable because of several limitations.
In 2005, the
Healthcare Effectiveness Data and Information Set (HEDIS) introduced a
quality measure to assess the receipt of DMARDs among patients with
rheumatoid arthritis, according to background information in the
article.
HEDIS data from
Medicare managed care plans provide a nationally representative sample
of the managed care population older than 65 years.
Gabriela
Schmajuk, M.D., M.S., of Stanford University, Stanford, Calif., and
colleagues examined socio-demographic, community, and health plan
factors associated with DMARD receipt among Medicare managed care
enrollees.
The researchers
analyzed HEDIS data for 93,143 senior citizen patients who were at least
65 years old with at least 2 diagnoses of RA within a year (during
2005-2008). The average age of patients was 74 years; 75 percent were
women and 82 percent were white.
Overall
performance on the HEDIS measure for RA in the study sample was 63
percent.
In 2005, 59
percent of the sample received a DMARD, increasing to 67 percent in
2008. The largest difference in performance on the HEDIS RA measure was
based on age: participants 85 years and older had a 30 percentage point
lower rate of DMARD receipt compared with patients 65 to 69 years old.
Other
participant categories less likely to receive a DMARD were men,
individuals identified by race as black or other, individuals with low
personal income, participants in lower socioeconomic status zip codes,
and individuals in the Middle and South Atlantic regions.
"Patients living
in a health professional shortage area had slightly lower performance
(-3 percentage points). In addition, patients enrolled in a for-profit
health plan had a 4 percentage point lower rate of DMARD receipt
compared with patients enrolled in a not-for-profit health plan," the
authors write.
Performance
varied widely by health plan, with rates ranging from 16 percent to 87
percent.
The researchers
write that although RA was once an inevitably deforming and disabling
condition, the development of new DMARDs and support for their early use
has dramatically improved clinical outcomes for many patients.
"This study
suggests that one mechanism for the socio-demographic disparities in RA
outcomes in the United States may relate to differences in DMARD
receipt,"
"Given the
enormous individual and societal costs associated with RA, and
increasing substantial evidence that DMARDs can reduce these costs,
variations in DMARD receipt based on demographics, socioeconomic status,
and geography are unacceptable.
“Because
optimizing DMARD use is the primary mechanism for decreasing the
significant public health impact of RA in the United States, targeting
educational and quality improvement interventions to patients who are
underusing DMARDs and their clinicians will be important to eliminate
these disparities. Additional studies of population-wide cohorts that
include clinical data and disease activity measures are needed to
validate our findings."
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