Quality Care in Seniors With New-Onset Rheumatoid Arthritis: A Canadian Perspective

University of Toronto, Toronto, Ontario, Canada.
Arthritis care & research 01/2011; 63(1):53-7. DOI: 10.1002/acr.20304
Source: PubMed

ABSTRACT To estimate the percentage of seniors with rheumatoid arthritis (RA) receiving disease-modifying antirheumatic drugs (DMARDs) within the first year of diagnosis.
We assembled an incident RA cohort from Ontario physician billing data for 1997-2006. We used a standard algorithm to identify 24,942 seniors with RA based on ≥ 2 billing codes ≥ 60 days apart but within 5 years. Drug exposures were obtained from pharmacy claims data. We followed subjects for 1 year, assessing if they had been exposed (defined as ≥ 1 prescription) to 1 or more DMARDs within the first year of RA diagnosis. We assessed secular trends and differences for subjects who had received rheumatology care (defined as ≥ 1 rheumatology encounter) versus those who had not.
In total, only 39% of the 24,942 seniors with new-onset RA identified over 1997-2006 were exposed to DMARD therapy within 1 year of diagnosis. This increased from 30% in 1997 to 53% in 2006. Patients whose care involved a rheumatologist were more likely to be exposed to DMARDs than those who had no rheumatology care. In 2006, 67% of subjects receiving rheumatology care were exposed to DMARDs versus 21% of those with no rheumatology care.
Improvements in RA care have occurred, but more efforts are needed. Subjects receiving rheumatology care are much more likely to receive DMARDs as compared to those with no rheumatology care. This emphasizes the key role of rheumatologists.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study was conducted to investigate disease-modifying antirheumatic drug (DMARD) utilization in Korean elderly patients with rheumatoid arthritis (RA). We used data from January 1, 2005 to June 30, 2006 from the Health Insurance Review and Assessment Service claims database. The study subjects were defined as patients aged 65 yr or older with at least two claims with a diagnosis of RA. DMARD use was compared by the patients' age-group, gender, medical service, and geographic divisions. The patterns of DMARD use in mono- and combination therapy were calculated. RA medication use was calculated by the number of defined daily doses (DDD)/1,000 patients/day. A total of 166,388 patients were identified during the study period. DMARD use in RA patients was 12.0%. The proportion of DMARD use was higher in the younger elderly, females, and patients treated in big cities. Hydroxychloroquine was the most commonly used DMARD in monotherapy, and most of the combination therapies prescribed it with methotrexate. DMARD use in elderly RA patients was noticeably low, although drug prescriptions showed an increasing trend during the study period, clinicians may need to pay more attention to elderly RA patients.
    Journal of Korean medical science 02/2014; 29(2):210-6. DOI:10.3346/jkms.2014.29.2.210 · 0.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To assess the extent to which an online patient decision aid reduced decisional conflict and improved self-management knowledge/skills in patients who were considering methotrexate for rheumatoid arthritis (RA). Methods: We used a mixed methods pre-post study design. Eligible participants had a diagnosis of RA, had been prescribed methotrexate but were unsure about starting it, and had access to the internet. Outcome included: 1) Decisional Conflict Scale; 2) Methotrexate in RA Knowledge Test; 3) Effective Consumer Scale. Paired t-tests were used to assess changes before and after the intervention. Randomly selected participants were interviewed at the end of the study. Results: Of 30 participants, 23 were women. Mean age was 54.9 years (SD=14.9) and the median disease duration was 1 year (IQR=0.3; 5.0). Decisional conflict changed from 49.50 (SD=23.17) pre-intervention to 21.83 (SD=24.12) post-intervention (change=-27.67, 95% CI= -15.44, -39.89; p<0.001). Knowledge of methotrexate improved (pre: 30.62, SD=9.26; post: 41.67, SD=6.81; p<0.001), but there was no change in effective consumer attributes (pre: 68.24, SD=12.46; post: 72.94, SD=12.74; p=0.15). Three themes emerged from interviews of 11 participants: 1) Seeking confirmation of one's knowledge of methotrexate; 2) Amplifying reluctance when they encountered information contradicting their own experiences; 3) Clarifying thoughts about the next step during the process. Conclusion: Patients' decisional conflict and knowledge improved after using the patient decision aid. Interview findings further highlighted the power of patients' prior knowledge and experiences with RA on how they approach the information presented in a decision aid. © 2014 American College of Rheumatology.
    10/2014; 66(10). DOI:10.1002/acr.22319
  • Source
    04/2014; 66(4):775-82. DOI:10.1002/art.38323

Full-text (2 Sources)

Available from
Oct 22, 2014