title: Trends in disease modifying antirheumatic drug prescription in early rheumatoid arthritis are influenced more by hospital setting than patient or disease characteristics.
abstract: OBJECTIVE
  To characterise temporal trends and factors associated with the prescription of disease modifying antirheumatic drugs (DMARDs) at the initial consultation in early rheumatoid arthritis (RA).
  
  
  METHODS
  Data from 2584 patients with early RA at 19 hospitals were extracted from the Swedish Rheumatoid Arthritis Register for the period 1997-2001. Disease characteristics and DMARD prescription at first consultation with the rheumatologist were investigated using cross tabulation and logistic regression.
  
  
  RESULTS
  DMARD prescriptions, particularly for methotrexate, increased from 1997 to 2001 independently of patient characteristics. Stratification by hospital type showed that patients in district hospitals were less likely to be prescribed DMARDs than those in university hospitals (adjusted odds ratio (OR) = 0.53 (95% confidence interval (CI) 0.40 to 0.69), p<0.001), independently of confounding factors. Association of the DAS28 with the likelihood of DMARD prescription was greater among patients attending district hospitals (OR = 1.65 (1.34 to 2.02), p<0.001) than those at university hospitals (OR = 1.23 (1.07 to 1.41), p = 0.003) and county hospitals (OR = 1.34 (1.01 to 1.63), p = 0.003). Interaction testing indicated that the difference was significant (p = 0.007).
  
  
  CONCLUSIONS
  Temporal trends in DMARD prescription indicate an increasingly aggressive approach to disease management among Swedish rheumatologists. However, the association of hospital type with DMARD prescription suggests that the adoption of research findings in clinical care varies considerably.
authors.affiliation: Medical Management Centre, Department of Learning, Informatics, Management & Ethics, Karolinska Institutet, Karolinska University Hospital D2:01, 171 76 Stockholm, Sweden. Cheryl.Cullinane-Carli@karolinska.se
authors.forename: C
authors.initials: C
authors.lastname: Carli
authors.forename: A G C
authors.initials: AG
authors.lastname: Ehlin
authors.forename: L
authors.initials: L
authors.lastname: Klareskog
authors.forename: S
authors.initials: S
authors.lastname: Lindblad
authors.forename: S M
authors.initials: SM
authors.lastname: Montgomery
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006761:Hospitals; D006767:Hospitals, District; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D016017:Odds Ratio; D010044:Outpatient Clinics, Hospital; D010818:Practice Patterns, Physicians'; D012219:Rheumatology
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate