Session Information
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Within the Veteran Affairs (VA) health care system, there are often large geographic distances between patients and rheumatology providers. The purpose of this study was to determine if Veterans with inflammatory arthritis (IA) living far from VA rheumatology sites utilize rheumatology providers and therapies less frequently than patients located close to rheumatology sites.
Methods: Veterans with IA were included if they had ≥2 international classification of diseases-9 (ICD9) codes for rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis, prior to the beginning of the study period (January 1, 2014 to December 31, 2014). Geocoding was used to calculate the geographic distance between the coordinates of Veteran’s home and the nearest VA site with rheumatology services. Exposure to medications was determined by medication dispensation. Primary and secondary stop codes were used to identify rheumatology encounters, defined as face-to-face visits with a rheumatology provider. Data sources included the national Corporate Data Warehouse and the Managerial Cost and Accounting Pharmacy dispensing data.
Results: The study included 75,804 Veterans, with 61.2%, 28.4%, and 10.4% living <40 miles, 40-99 miles and ≥100 miles from the nearest rheumatology site, respectively. The mean age ranged from 66.4 – 66.6, and 89 – 91% were male (Table 1). Rheumatology encounter(s) occurred for 43.7%, 33.7%, and 24.3% of Veteran living <40 miles, 40-99 miles and ≥100 miles from a rheumatology site, respectively (Figure 1). Higher percentages of Veterans living within 40 miles of a VA rheumatology site were exposed to non-biologic DMARD(s), biologic DMARD(s), and corticosteroid(s), compared to Veterans living 40-99 miles or >100 miles from a VA rheumatology site (Figure 2).
Conclusion: Rheumatology encounters occurred for fewer Veterans with IA living farther from VA rheumatology sites than Veterans living closer to VA rheumatology sites. Exposure to biologic DMARDs, non-biologic DMARDs, and corticosteroids was also associated with closer geographic proximity to VA rheumatology sites.
| Table 1. Demographics, rheumatology encounters, and exposure to therapies | ||||||
|
<40 miles n = 46,395 |
40-99 miles n = 21,536 |
≥100 miles n = 7,873 |
||||
|
No. (%) or ±SD |
95% CI |
No. (%) or ±SD |
95% CI |
No. (%) or ±SD |
95% CI |
|
| Age, mean |
66.4 ± 12.6 |
|
66.6 ± 11.7 |
|
66.4 ± 11.8 |
|
| Male |
41,270 (89.0) |
|
19,601(91.0) |
|
7,183 (91.2) |
|
| White Race |
35,121 (75.7) |
|
17,057 (79.2) |
|
6,329 (80.4) |
|
| Black Race |
6,463 (13.9) |
|
2,064 (9.6) |
|
466 (5.9) |
|
| Other Race† |
1,123 (2.4) |
|
372 (1.7) |
|
267 (3.4) |
|
| Unknown Race ‡ |
3,688 (7.9) |
|
2,043 (9.5) |
|
811 (10.3) |
|
| # Veterans with ≥1 rheumatology encounter |
20,742 (44.7) |
44.3-45.2 |
7,365 (34.2) |
33.6-34.8 |
1,953 (24.8) |
23.9-25.8 |
| # Veterans exposed to non-biologic DMARD(s)§ |
16,744 (36.1) |
35.7-36.5 |
7,479 (34.7) |
34.1-35.4 |
2,693 (34.2) |
33.2-35.3 |
| # Veterans exposed to biologic DMARD(s)§§ |
10,413 (22.4) |
22.1-22.8 |
4,337 (20.1) |
19.6-20.7 |
1,516 (19.3) |
18.4-20.1 |
| # Veterans exposed to corticosteroid(s)§§§ |
15,658 (33.7) |
33.3-34.2 |
6,640 (30.8) |
30.2-31.5 |
2,372 (30.1) |
29.1-31.2 |
| † Other Race includes American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and Asian | ||||||
| ‡ Unknown race includes declined to answer, unknown by patient, and missing data | ||||||
| §Non-biologic DMARDS included apremilast, auranofin, azathioprine, chloroquine, cyclophosphamide, cyclosporine, hydroxychloroquine, gold sodium thiomalate, leflunomide, methotrexate, minocycline, penicillamine, sulfasalazine, and tofacitinib | ||||||
| §§Biologic DMARDS included § Non-biologic DMARDS included adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, secukinumab, tocilizumab, and ustekinumab | ||||||
| §§§Corticosteroids included betamethasone, cortisone, dexamethasone, hydrocortisone, methylprednisolone, prednisolone, prednisone, triamcinolone | ||||||
Figure 1. Rheumatology encounter(s) and distance from closest VA rheumatology site
Figure 2. Exposure to therapy and distance from closest VA rheumatology site
To cite this abstract in AMA style:
Walsh JA, Burningham Z, Teng MS CC, Clegg DO, Sauer PhD BC. Rheumatology Care Utilization and Geographic Distance from Rheumatology Sites within the United States Veteran Affairs Health Care System [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/rheumatology-care-utilization-and-geographic-distance-from-rheumatology-sites-within-the-united-states-veteran-affairs-health-care-system/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatology-care-utilization-and-geographic-distance-from-rheumatology-sites-within-the-united-states-veteran-affairs-health-care-system/