Where you Live Affects Your Chance of Having Received DMARD Therapy

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Where you Live Affects Your Chance of Having Received DMARD Therapy

Category:  30 Health services research

Deborah Shipton, Jun Guan, Badley

Toronto Western Research Institute, The Arthritis Community Research and

Evaluation Un, ON, Canada

Presentation Number: 132

Poster Board Number: 132

Keywords: DMARD, Rheumatology services, healthcare accessibility

Disease modifiying antirheumatic drugs (DMARD) are the cornerstone of

treatment for rheumatoid arthritis (RA) and are usually prescribed by

rheumatologists. Even within our publicly funded health care system, which

provides universal access to physician services, availability of local

rheumatology services varies by geographic area.

Purpose: To determine whether the use of DMARD therapy in the population is

determined by need (prevalence of RA) or by use of rheumatology services.

Method: We identified all individuals with likely RA living in each of 15

health care planning areas in a defined geographic region from the regional

physician claims database for years 1994-1998. This database includes 95% of

all physician visits. Individuals with likely RA were defined as having made

1 or more visits per year to a physician for RA for 3 consecutive years.

DMARD prescription data were obtained for the same years from the Regional

Drug Benefits plan database. This drug plan covers all residents aged 65

years and over for prescription drug costs; therefore analysis of DMARD use

was restricted to this age group.

Results: 33,756 individuals with likely RA were identified, representing

0.4% of the adult population (1% of the population aged 65+), with a

female:male ratio of 2.9, a mean age of 59 yrs and an average of 5 physician

visits per year for RA. Overall 56% of the likely RA individuals 65+ had

made 1 or more visits to a rheumatologist, and 55% of the likely RA

individuals 65+ had received DMARD therapy. The prevalence of likely RA in

those aged 65+ ranged from 0.7% to 1.4%. There was considerable variation by

area in the proportion seeing a rheumatologist (34%-73%), which was not

correlated with the prevalence of likely RA. During the 3 years study

period, 78% of individuals who saw rheumatologists for RA received DMARDS,

compared with 17% who saw only a family physician. Across areas, the

proportion getting DMARDs was highly associated with the proportion seeing a

rheumatologist (r=0.9, p<0.001), but not with the prevalence of RA (r=-0.2,

p=0.41)

Conclusion: Older people with likely RA who live in areas where there is

good access to rheumatology (as indicated by a high proportion seeing

rheumatologists) were more likely to have received DMARD therapy, but this

was not associated with potential need as reflected by the prevalence of

likely RA in older individuals, suggesting that where you live affects

access to treatment.