Gaps in care for rheumatoid arthritis: A population study.

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Saw this on another list and thought some of you might be interested.

Nina

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 recommendearly, aggressive, and persistent use of disease-modifying antirheumaticdrugs (DMARDs) to prevent joint damage in all people with activeinflammation, and evaluation by a rheumatologist, when possible. Thisresearch assesses whether care for RA, at a population level, is consistentwith current treatment guidelines. METHODS: Using administrative billingdata from the Ministry of Health in 1996-2000, all prevalent RA cases inBritish Columbia, Canada were identified. Data were obtained on allmedications and all provincially-funded health care services. RESULTS: Weidentified 27,710 RA cases, yielding a prevalence rate of 0.76%, consistentwith epidemiologic studies. DMARD use was inappropriately low. Only 43% ofthe 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 werenot 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 usedas combination therapy with continuous rheumatologist care. DMARDs were usedby 84% and 73%, 40%, and 10% of people followed by rheumatologistscontinuously and intermittently, internists, and family physicians,respectively (P < 0.001). NSAID use, physiotherapy, and orthopedic surgerieswere similar across these 4 care groups. CONCLUSION: RA care in the BritishColumbia population was not consistent with current treatment guidelines.Efforts to educate family physicians and consumers about the shift in RAtreatment paradigms and to improve access to rheumatologists are needed.PMID: 15818655http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=15818655 & dopt=Abstract