Treatment of older adult patients diagnosed with rheumatoid arthritis: improved but not optimal.
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 >or=85 were 74% less likely (95% CI 69-79%) compared with patients ages 65-74.


CONCLUSIONS
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.
Schmajuk
Gabriela
G
Stanford University, Palo Alto, California, USA.
Schneeweiss
Sebastian
S
Katz
Jeffrey N
JN
Weinblatt
Michael E
ME
Setoguchi
Soko
S
Avorn
Jerry
J
Levin
Raisa
R
Solomon
Daniel H
DH
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015331:Cohort Studies; D019992:Databases as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010414:Pennsylvania; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D018501:Antirheumatic Agents