title: Physician Preferences and Variations in Prescription of Biologic Drugs for Rheumatoid Arthritis: A Register-Based Study of 4,010 Patients in Sweden.
abstract: OBJECTIVE
  The prescription of biologic drugs for rheumatoid arthritis (RA) patients has varied considerably across different regions. Previous studies have shown physician preferences to be an important determinant in the decision to select biologic disease-modifying antirheumatic drugs (bDMARDs) rather than nonbiologic, synthetic DMARDs (sDMARDs) alone. The aim of this study was to test the hypothesis that physician preferences are an important determinant for prescribing bDMARDs for RA patients in Sweden.
  
  
  METHODS
  Using data from the Swedish Rheumatology Quality Register, we identified 4,010 RA patients who were not prescribed bDMARDs during the period 2008-2012, but who, on at least 1 occasion, had an sDMARD prescription and changed treatment for the first time to either a new sDMARD or a bDMARD. Physician preference for the use of bDMARDs was calculated using data on each physician's prescriptions during the study period. The relationship between prescription of a bDMARD and physician preference, controlling for patient characteristics, disease activity, and the physician's local context was evaluated using multivariate logistic regression.
  
  
  RESULTS
  When adjusting for patient characteristics, disease activity, and the physician's local context, physician preference was an important predictor for prescription of bDMARDs. Compared with patients of a physician in the lowest preference tertile, patients of physicians in the highest and middle tertiles had an odds ratio for receiving bDMARDs of 2.8 (95% confidence interval [95% CI] 2.13-3.68) and 1.28 (95% CI 1.05-1.57), respectively.
  
  
  CONCLUSIONS
  Physician preference is an important determinant for prescribing bDMARDs.
authors.affiliation: Linköping University, Linköping, Sweden.
authors.forename: Almina
authors.initials: A
authors.lastname: Kalkan
authors.affiliation: Linköping University, Linköping, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Husberg
authors.affiliation: Linköping University, Linköping, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Hallert
authors.affiliation: Linköping University, Linköping, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Roback
authors.affiliation: Linköping University and County Council of Östergötland, Linköping, Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Thyberg
authors.affiliation: Linköping University and County Council of Östergötland, Linköping, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Skogh
authors.affiliation: Linköping University, Linköping, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Carlsson
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D001291:Attitude of Health Personnel; D001688:Biological Products / Q000627:therapeutic use*; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012042:Registries; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products