title: Receipt of glucocorticoid monotherapy among Medicare beneficiaries with rheumatoid arthritis.
abstract: OBJECTIVE
  Using disease-modifying antirheumatic drugs (DMARDs) improves outcomes in rheumatoid arthritis (RA) and is a nationally endorsed quality measure. We investigated the prevalence and predictors of receiving glucocorticoids alone for the treatment of RA in a nationwide sample of Medicare beneficiaries.
  
  
  METHODS
  Among individuals ages ≥65 years with RA enrolled in the Part D prescription drug benefit in 2009, we compared those with ≥1 DMARD claim to those receiving glucocorticoid monotherapy, defined as no DMARD claim and an annual glucocorticoid supply of ≥180 days or an annual dose of ≥900 mg of prednisone or equivalent. We fit multivariable models to determine the sociodemographic and clinical factors associated with glucocorticoid monotherapy.
  
  
  RESULTS
  Of 8,125 beneficiaries treated for RA, 10.2% (n = 825) received glucocorticoids alone. Beneficiaries with low incomes were more likely to receive glucocorticoids alone (12.3%; 95% confidence interval [95% CI] 10.9-13.8% versus 9.4%; 95% CI 8.6-10.1%), as were those living in certain US regions. More physician office visits and hospitalizations were associated with glucocorticoid monotherapy. Individuals who had no contact with a rheumatologist were significantly more likely to receive glucocorticoids alone (17.5%; 95% CI 16.0-19.0% versus 8.5%; 95% CI 7.4-9.5% for those with no rheumatology visits versus 1-4 visits).
  
  
  CONCLUSIONS
  Approximately 1 in 10 Medicare beneficiaries treated for RA received glucocorticoids without DMARDs in 2009. Compared to DMARD users, glucocorticoid users were older, had lower incomes, were more likely to live in certain US regions, and were less likely to have seen a rheumatologist, suggesting persistent gaps in quality of care despite expanded drug coverage under Part D.
authors.affiliation: San Francisco General Hospital and University of California, San Francisco.
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.forename: Chris
authors.initials: C
authors.lastname: Tonner
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schmajuk
authors.forename: Grace A
authors.initials: GA
authors.lastname: Lin
authors.forename: Amal N
authors.initials: AN
authors.lastname: Trivedi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D016009:Chi-Square Distribution; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D004608:Eligibility Determination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D007342:Insurance Benefits; D016015:Logistic Models; D008297:Male; D054524:Medicare Part D; D015999:Multivariate Analysis; D009819:Office Visits; D010818:Practice Patterns, Physicians'; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids