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Mass. community health centers report need for better access to rheumatology care
The majority of community health centers surveyed in Massachusetts indicated the need for better access to rheumatology care, according to recent study results.
Researchers sent a 40-item survey to medical directors at 77 Massachusetts community health center (CHC). Prevalence of rheumatic diseases at the centers, prescribing practices of immunosuppressive medications and possible interventions to improve care were assessed. CHC characteristics were compared with rheumatology-specific items, and responses were stratified by the need for improved access to rheumatology care.
Thirty-six medical directors returned surveys, with 55% indicating the need for better access to rheumatology care. Sixty-seven percent described their CHC as federally qualified.
“The majority of respondents felt their CHC physicians would start neither a rheumatoid arthritis [RA] patient on a disease-modifying antirheumatic drug [DMARD; 86%] nor a systemic lupus erythematosus [SLE] patient on an immunosuppressant [94%],” the researchers reported. Fifty-eight percent of directors, however, said physicians would refill a DMARD and 50% would continue an immunosuppressant.
CHCs that reported the need for better access to rheumatology care indicated a greater percentage of their patients had private insurance or Medicaid who required outside referrals compared with CHCs not indicating improved access (P<.05). Language and insurance status were barriers to obtaining care.
Patient navigators, used for care coordination, were the first-choice intervention for 57% of directors who ranked possible intervention options.
“This study demonstrated that a significant percentage of CHCs across Massachusetts require better access to rheumatology care, particularly for their SLE and RA patients,” the researchers concluded. “This increased need should be taken into account as the relationship between subspecialty care and primary care through the patient-centered medical home is further defined.
“Increased funding to CHCs under the Affordable Care Act should promote innovative strategies to improve subspecialty areas.”
Disclosure: Researcher Daniel H. Solomon, MD, MPH, has received grant support from Abbott, Amgen and Lilly. He serves on two Pfizer sponsored trial committees in unpaid roles. He is a consultant to CORRONA and receives royalties from UpToDate.