Study finds many patients with RA not receiving recommended drugs

A recently published study in the Journal of the American Medical Association notes that 63% of Medicare-managed patients with rheumatoid arthritis receive any disease-modifying anti-rheumatic drugs.

Which patients receive the medications varies “dramatically” by each individual patient’s health care plan, economic status and location, the study found.

“Among patients with a true diagnosis of rheumatoid arthritis, closer to 90% should be receiving treatment,” lead author Gabriela Schmajuk, MD, stated in a Stanford University Medical Center press release. “We counted patients who received the bare minimum amount of treatment, and still a large proportion of patients aren’t getting the medication they need. We set the bar very low.”

“The reason treatment is so important is that, if left untreated, one-third of patients with rheumatoid arthritis will become disabled within 5 years of diagnosis,” she added.

The investigators examined a quality measure by the Healthcare Effectiveness Data and Information Set (HEDIS) in 2005 to monitor the receipt of disease-modifying anti-rheumatic drugs among patients with rheumatoid arthritis (RA). HEDIS data was analyzed for 93,143 patients who were 65 years of age or older with at least two diagnoses of RA within a measurement year between 2005 and 2008. The investigators used logistic regression models with generalized estimating equations to determine factors associated with disease-modifying anti-rheumatic drug receipt, and logistic regression was used to adjust health plan performance for case mix.

Overall performance on the HEDIS measure for RA was 59% in 2005 and increased to 67% in 2008. The largest discrepancy in performance was found to be age-based, with patients 85 years of age or older receiving the medications an average of 30% less when compared with patients 65 to 69 years of age.

“Patients who had low income received [disease-modifying anti-rheumatic drugs] less frequently than wealthier patients,” Schmajuk stated in the release. “Blacks received medications less frequently than Whites. We also found that patients who lived in the mid- and south-Atlantic regions received medications less frequently than other areas, particularly the west coast states.”

Health care plans have a significant impact upon which patients receive proper treatment, the study noted, drawing a correlation between lower percentage points and patients who were enrolled in for-profit health plans.

“Some plans were doing really well with over 80% of patients being treated appropriately,” Schmajuk stated. “Other plans had fewer than 20% of patients getting appropriate care, which is really worrisome. We know this wasn’t because of the individual characteristics of patients since the health plan results were adjusted for age, race, income and geographic region.”

References:
http://med.stanford.edu
Schmajuk G, et al. Receipt of disease-modifying antirheumatic drugs among patients with rheumatoid arthritis in Medicare managed care plans. JAMA. 2011;305(5):480-486. doi: 10.1001/jama.2011.67.
Disclosure: Co-author Amal N. Trivedi, MD, MPH reports receipt of compensation from Merck (for editing a chapter of the Merck Manual) and from the Pzifer (for receiving a Health Policy Scholars Award from the Pzifer Foundation). All other authors have reported no financial conflicts.

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