title: Impact of TennCare reform on care of patients with rheumatic diseases.
abstract: BACKGROUND
  As a consequence of cost-cutting changes, termed "TennCare reform," to Tennessee's state-funded health care plan, a number of beneficiaries have either had their benefits substantially reduced or have been disenrolled entirely. The purpose of this study was to determine the impact of these reforms on the health of patients with chronic rheumatic diseases.
  
  
  METHODS
  We determined differences with adherence to scheduled appointments in an urban academic rheumatology clinic in the 3 months before and in the 3 months after TennCare reform. A telephone survey was conducted to determine plans for future rheumatic care among those patients scheduled to be seen in this clinic in the 3 months after TennCare reform.
  
  
  RESULTS
  Overall, 402 of the 601 patients scheduled for a rheumatology clinic appointment before TennCare reform (67%) adhered to their scheduled rheumatology appointment, compared with 362 of 595 patients (61%) scheduled for an appointment after TennCare reform, a difference that was statistically significant (P = 0.034). After TennCare reform, patients who did not adhere with clinic follow-up were more likely to have been disenrolled from TennCare (P < 0.001). By telephone survey, among those who were disenrolled from TennCare, almost half indicated that they did not know where they were going to receive future rheumatic disease care. Among those who retained TennCare, less than half indicated that they could afford to purchase all of their medications.
  
  
  CONCLUSIONS
  TennCare reform has significantly limited care for patients with rheumatic diseases. The long-term consequences of this merit future study.
authors.affiliation: University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Aliza
authors.initials: A
authors.lastname: Braverman
authors.forename: Baowei
authors.initials: B
authors.lastname: Tang
authors.forename: Jessica
authors.initials: J
authors.lastname: Cross
authors.forename: Syed Hasan
authors.initials: SH
authors.lastname: Raza
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Nesheiwat
authors.forename: Laura D
authors.initials: LD
authors.lastname: Carbone
mesh_terms: D000328:Adult; D005260:Female; D018166:Health Care Reform; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D012216:Rheumatic Diseases / Q000628:therapy*