ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 0203

Agreement of Administrative Pharmacy Dispensing with Patient-Reported Use of Oral Glucocorticoids in a Rheumatoid Arthritis Cohort

Beth Wallace1, Bryant England2, Joshua Baker3, Sauer brian4, Jorge Rojas5, Punyasha Roul6, Michael George7, Katherine Wysham8, Hannah Brubeck9, Isaac Smith10, Liron Caplan11, Paul Monach12, Gail Kerr13, Gary Kunkel14, Tawnie Braaten15, Ted Mikuls2 and grant Cannon16, 1Michigan Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, 2University of Nebraska Medical Center, Omaha, NE, 3Department of Medicine, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, 4Salt Lake City VA/University of Utah, Salt Lake City, UT, 5Seattle VA, Mexico, Mexico, 6UNMC, Omaha, NE, 7University of Pennsylvania, Philadelphia, PA, 8VA PUGET SOUND/UNIVERSITY OF WASHINGTON, Seattle, WA, 9VA Puget Sound Health Care System, Seattle, WA, 10Duke Department of Medicine; VA Durham Healthcare System, Durham, NC, 11Univ of Colorado School of Medicine/Rocky Mtn Regional Veterans Affairs Medical Center, Aurora, CO, 12VA Boston Healthcare System, Boston, MA, 13Washington DC VAMC/Georgetown and Howard Universities, Washington, DC, 14University of Utah/VA Salt Lake City Health Care, Salt Lake City, UT, 15UNIVERSITY OF UTAH, Salt Lake City, UT, 16University of Utah and Salt Lake City VA, Salt Lake City, UT

Meeting: ACR Convergence 2024

Keywords: glucocorticoids, Health Services Research, Surveys

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Date: Saturday, November 16, 2024

Title: Health Services Research – ACR/ARP Poster I

Session Type: Poster Session A

Session Time: 10:30AM-12:30PM

Background/Purpose: Administrative claims are often used to evaluate oral glucocorticoid (GC) use in RA for clinical and research purposes, despite limited evidence to support their accuracy. A prior study found a positive predictive value (PPV) of 65% for for GC use in Medicare claims compared to physician report in the CorEvitas registry (Galvao et al Pharm Drug Saf 2023). We are not aware of studies evaluating accuracy of GC claims vs. self-reported use.

Methods: As part of a quality improvement initiative to improve GC use assessment in RA, patients at 7VA Rheumatoid Arthritis (VARA) registry sites filled out a 6-item questionnaire between Oct. 2023 and May 2024. Three items reflecting commonly used definitions of GC use (current use and recent use in the past 30 and 90 days, dichotomized yes/no) were used as reference standards to evaluate claims-based algorithms of prednisone dispensing from the VA Corporate Data Warehouse (CDW). We calculated sensitivity, specificity, PPV, and negative predictive value for each algorithm using the questionnaire item as a reference standard. As there is no validated benchmark for GC use, we calculated Cohen’s Kappa to assess agreement without a presumed reference standard. The questionnaire also assessed two potential barriers to accurate claims-based evaluation of GC use: “stockpiling” and obtaining GC from non-VA providers.

Results: Of 346 questionnaires, 312 (90.1%) were from unique patients and could be linked to CDW pharmacy claims. Of these, 36 (11.5%) reported current GC use, 56 (17.9%) reported use in the past 30 days, and 67 (21.5%) reported use in the past 90 days. Demographics reflect those of prior studies in this population (Table 1).

Table 2 shows the performance of each claims-based algorithm. The algorithm for current GC use had a sensitivity of 67%, specificity of 98%, and PPV of 80%. Algorithms for use in the past 30 and 90 days had sensitivities of 63% and 63%, specificities of 96% and 94%, and PPVs of 80% and 75%, respectively. Kappas were substantial and similar across algorithms (64-68%). Seventy respondents (22.4%) reported a GC stockpile. Eighty-nine respondents (28.5%) reported obtaining GC from a non-VA provider; 21 (6.7%) had done so in the past year.

Conclusion: Claims-based algorithms evaluating current and recent GC use performed acceptably compared to self-report, and better than prior assessments benchmarked on physician report. However, self-report of current GC use showed only 68% agreement with an active prednisone prescription. This suggests that a simple review of active medications by the physician is often inaccurate, even when assessing ongoing GC use. Agreement and PPV worsened as the interval being evaluated increased, which may reflect recall bias captured in the questionnaire vs. reduced accuracy in claims-based metrics applied to a longer assessment period. Over 1 in 5 patients reported having a GC stockpile, and 1 in 15 reported obtaining GC from outside VA in the past year, reflecting additional barriers to accurately estimating GC use via pharmacy claims.

Supporting image 1

Table 1: Characteristics of study population

Supporting image 2

Table 2: Performance characteristics for CDW claims-based algorithms vs. questionnaire items assessing self-reported glucocorticoid use


Disclosures: B. Wallace: None; B. England: Boehringer-Ingelheim, 5; J. Baker: CorEvitas, LLC, 2, Cumberland Pharma, 2, Formation Bio, 2, Horizon, 5; S. brian: None; J. Rojas: None; P. Roul: None; M. George: AbbVie/Abbott, 2, GlaxoSmithKlein(GSK), 5, Janssen, 5, Pfizer, 2, 5; K. Wysham: None; H. Brubeck: None; I. Smith: None; L. Caplan: None; P. Monach: HI-Bio, 2; G. Kerr: AstraZeneca, 1, Boehringer-Ingelheim, 6, Bristol-Myers Squibb(BMS), 1, CSL Behring, 6, Janssen, 6, Novartis, 1, Pfizer, 6, Sanofi, 6, UCB, 1; G. Kunkel: None; T. Braaten: None; T. Mikuls: Elsevier, 9, Horizon Therapeutics, 2, 5, Pfizer, 2, Sanofi, 2, UCB Pharma, 2, Wolters Kluwer Health (UpToDate), 9; g. Cannon: None.

To cite this abstract in AMA style:

Wallace B, England B, Baker J, brian S, Rojas J, Roul P, George M, Wysham K, Brubeck H, Smith I, Caplan L, Monach P, Kerr G, Kunkel G, Braaten T, Mikuls T, Cannon g. Agreement of Administrative Pharmacy Dispensing with Patient-Reported Use of Oral Glucocorticoids in a Rheumatoid Arthritis Cohort [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/agreement-of-administrative-pharmacy-dispensing-with-patient-reported-use-of-oral-glucocorticoids-in-a-rheumatoid-arthritis-cohort/. Accessed .
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to ACR Convergence 2024

ACR Meeting Abstracts - https://acrabstracts.org/abstract/agreement-of-administrative-pharmacy-dispensing-with-patient-reported-use-of-oral-glucocorticoids-in-a-rheumatoid-arthritis-cohort/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology