title: Documented tuberculin skin testing among infliximab users following a multi-modal risk communication interventions.
abstract: OBJECTIVE
  Following its licensure, tuberculosis (TB) was reported as a potential adverse effect of infliximab. Subsequently, the product circular was changed to recommend tuberculin skin testing before patients received infliximab, which was reinforced by several risk communication efforts. The aim of this study was to evaluate patterns and predictors of documented tuberculin skin testing in patients before and after manufacturer, federal, and academic risk communications.
  
  
  METHODS
  Patients administered infliximab were identified from 11 health plans located throughout the United States, and claims data were examined to determine whether the patients had received a tuberculin skin test. Patients were divided into three cohorts depending on the timing of their first infliximab treatment in relation to the risk communication efforts.
  
  
  RESULTS
  The overall tuberculin skin testing rate doubled from 15.4% in the first cohort to 30.9% in the last cohort, while the rate of pre-infliximab treatment testing increased from 0 to 27.7% (Chi-squared test for trend, p < 0.0001 for both). Tuberculin skin testing rates were significantly higher in women, those with a diagnosis of rheumatoid or psoriatic arthritis, and those with a rheumatologist as prescriber. After multivariable analysis, only rheumatologist remained significantly associated with tuberculin skin testing.
  
  
  CONCLUSIONS
  Although the tuberculin skin testing rate was relatively low overall, tuberculin skin testing doubled over 30 months of ongoing risk communication efforts and under ascertainment likely occurred. We also found variation in the tuberculin skin testing rate associated with physician specialty. This study demonstrates a significant change in patient care following risk communication efforts.
authors.affiliation: Center for Health Care Policy and Evaluation, Minneapolis, MN, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Shatin
authors.forename: Nigel S B
authors.initials: NS
authors.lastname: Rawson
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.forename: M Miles
authors.initials: MM
authors.lastname: Braun
authors.forename: Carolyn K
authors.initials: CK
authors.lastname: Martin
authors.forename: Larry W
authors.initials: LW
authors.lastname: Moreland
authors.forename: Angela F
authors.initials: AF
authors.lastname: Becker
authors.forename: Nivedita M
authors.initials: NM
authors.lastname: Patkar
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Saag
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D000069285:Infliximab; D033181:Information Dissemination; D008297:Male; D008875:Middle Aged; D012306:Risk; D014374:Tuberculin Test / Q000706:statistics & numerical data*; D014397:Tuberculosis, Pulmonary / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab