title: Individual variations in treatment decisions by Swedish rheumatologists regarding biological drugs for rheumatoid arthritis.
abstract: OBJECTIVE
  In Sweden, reports indicate surprisingly large regional variation in prescription of biological drugs despite a growing number of clinical studies describing their beneficial effects and guidelines by professional organizations and agencies. Our objectives were to ascertain whether there is also variation between individual rheumatologists in prescribing biologics to patients with rheumatoid arthritis (RA) and to evaluate reasons for treatment choices.
  
  
  METHODS
  Ten hypothetical patient cases were constructed and presented to 26 rheumatologists in five regions in Sweden. The cases were based on actual cases and were thoroughly elaborated by a senior rheumatologist and pre-tested in a pilot study. The respondents were asked whether they would treat the patients with a biological agent (Yes/No) and to explain their decisions.
  
  
  RESULTS
  The response rate was 26/105 (25%). Treatment choices varied considerably between the rheumatologists, some prescribing biologics to 9/10 patients and others to 2/10. In five of the 10 hypothetical cases, approximately half of the respondents would prescribe biologics. No regions with particularly high or low prescription were identified. Both the decisions to prescribe biologics and also not to prescribe biologics were mainly motivated by medical reasons. Some rheumatologists also referred to lifestyle-related factors or the social function of the patient.
  
  
  CONCLUSIONS
  The choice of initiation of biologics varied substantially among rheumatologists presented with hypothetical patient cases, and there were also disparities between rheumatologists practicing at the same clinic. Treatment choices were motivated primarily by medical reasons. This situation raises concerns about a lack of consensus in RA treatment strategies.
authors.affiliation: Center for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University , Linköping , Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Kalkan
authors.forename: E
authors.initials: E
authors.lastname: Hallert
authors.forename: P
authors.initials: P
authors.lastname: Carlsson
authors.forename: K
authors.initials: K
authors.lastname: Roback
authors.forename: C
authors.initials: C
authors.lastname: Sjöwall
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology; D001688:Biological Products / Q000627:therapeutic use*; D003625:Data Collection; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012219:Rheumatology; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013548:Sweden
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products