RESEARCH - Gaps in care for rheumatoid arthritis: A population study.

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Arthritis Rheum. 2005 Apr 15;53(2):241-8.

Gaps in care for rheumatoid arthritis: A population study.

Lacaille D, Anis AH, Guh DP, Esdaile JM.

University of British Columbia, and Arthritis Research Centre of Canada,

Vancouver, British Columbia, Canada.

OBJECTIVE: Treatment guidelines for rheumatoid arthritis (RA) now recommend

early, aggressive, and persistent use of disease-modifying antirheumatic

drugs (DMARDs) to prevent joint damage in all people with active

inflammation, and evaluation by a rheumatologist, when possible. This

research assesses whether care for RA, at a population level, is consistent

with current treatment guidelines. METHODS: Using administrative billing

data from the Ministry of Health in 1996-2000, all prevalent RA cases in

British Columbia, Canada were identified. Data were obtained on all

medications and all provincially-funded health care services. RESULTS: We

identified 27,710 RA cases, yielding a prevalence rate of 0.76%, consistent

with epidemiologic studies. DMARD use was inappropriately low. Only 43% of

the entire RA cohort received a DMARD at least once over 5 years, and 35%

over 2 years. When used, DMARDs were started in a timely fashion, but were

not used consistently. Care by a rheumatologist increased DMARD use 31-fold.

Yet, only 48% and 34% saw a rheumatologist over 5 and 2 years, respectively.

DMARD use was significantly more frequent, persistent, and more often used

as combination therapy with continuous rheumatologist care. DMARDs were used

by 84% and 73%, 40%, and 10% of people followed by rheumatologists

continuously and intermittently, internists, and family physicians,

respectively (P < 0.001). NSAID use, physiotherapy, and orthopedic surgeries

were similar across these 4 care groups. CONCLUSION: RA care in the British

Columbia population was not consistent with current treatment guidelines.

Efforts to educate family physicians and consumers about the shift in RA

treatment paradigms and to improve access to rheumatologists are needed.

PMID: 15818655

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5818655 & dopt=Abstract

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