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Abstract Number: 673

Characterization of Psoriatic Arthritis [Psa] in a Large, Integrated Health Plan: Demographics, Referral Patterns and Care Management

Vibeke Strand1, Melody Chin2, Arijit Ganguli3, Ridhima Nerlekar4, Victoria Kelly5, Daniel Chin6 and Alice Pressman4, 1Biopharmaceutical Consultant, Portola Valley, CA, 2University of California, San Francisco, San Francisco, CA, 3AbbVie Inc., North Chicago, IL, 4Research, Development, and Dissemination, Sutter Health, Walnut Creek, CA, 5Rheumatology, Palo Alto Medical Foundation, Palo Alto, CA, 6Clinical Evidence and Outcomes, AbbVie, North Chicago, IL

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: psoriasis and psoriatic arthritis, Rheumatologic Conditions

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Session Information

Date: Sunday, November 8, 2015

Session Title: Spondylarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment Poster I: Clinical Aspects and Assessments

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Despite guidelines and evidence indicating that early diagnosis and treatment of PsA is critical, few studies have described referral and care-management patterns in a real-world setting. This study estimated the prevalence and incidence of PsA in the Sutter Health system, a large integrated U.S. health delivery network, and explored referral patterns and associated care-management practices within this population.

Methods: This was a retrospective review of electronic medical records and medical claims data of patients (age ≥18yrs) diagnosed with PsA (ICD-9-code 696.x) from 2011-2013. Medical chart review by a rheumatologist and/or registered nurse of a sample of prevalent and incident PsA patients was utilized to confirm the diagnosis. Prevalence and incidence rates (defined as no PsA report 2 years before the index PsA record) were estimated annually/100,000 patients. Care management included ascertainment of the physician type recording the first PsA diagnosis and/or treating the patient (specialist vs. non-specialist). Referral patterns ascertained the physician type making the first referral to a specialist.

Results:

Among 1,362,288 adults (≥18 yrs, 59% female) in the health plan, 2,029 were identified as diagnosed with PsA. The average 1-year period prevalence was 161/100,000; incidence: 43/100,000.  Mean age at incident diagnosis was 53 years (s=14.3) for women and 51 years (s=13.6) for men. Chart review revealed low rates for misclassification (5%) of PsA diagnosis. Approximately 54% of all PsA-related encounters were with rheumatologists. The majority of care was provided by rheumatology, primary care, and dermatology, accounting for 54%, 21%, and 19% encounters, respectively. Rheumatologists were first to diagnose PsA in 61% patients followed by primary care physicians (PCP): 24%, dermatologists: 10%, and others: 5%. Of those referred to a rheumatologist, 65% were referred by a PCP, followed by dermatologists: 6%, other rheumatologists: 4%, orthopedists: 3%, podiatrists: 2%, others: 3% and self/ no record: 18%.  Overall, in sampled patients, non-rheumatologist providers were less likely to perform a joint exam or document joint abnormalities, and no providers documented a disease activity score. Of 1665 prevalent cases with a documented encounter with a rheumatologist within the system, 557 (33%) were prescribed biologic agents, 851 (51%) DMARDs, and 359 (22%) steroids.  Among 2029 prevalent cases, 346 (17%) had no documented encounter with a Sutter Health rheumatologist; 30% were prescribed biologics and 26% DMARDs. Chart review revealed that most of these patients had had contact with specialists outside the network.

Conclusion:

Estimated prevalence of PsA in the Sutter Health System was similar to U.S. estimates: between 0.02 and 0.25%. Although rheumatologists provided the majority of care, many patients did not have a record of a rheumatology encounter. Further research is needed to better understand gaps in PsA health care in real world settings.

 


Disclosure: V. Strand, AbbVie, Alder, Amgen, BMS, Celgene, Genentech, Janssen, Novartis, Pfizer, and UCB, 5,Abbvie, Amgen, BMS, Celgene, Genentech, Janssen, Novartis, Pfizer, and UCB, 9; M. Chin, None; A. Ganguli, AbbVie, Inc., 3; R. Nerlekar, None; V. Kelly, None; D. Chin, AbbVie, 3; A. Pressman, None.

To cite this abstract in AMA style:

Strand V, Chin M, Ganguli A, Nerlekar R, Kelly V, Chin D, Pressman A. Characterization of Psoriatic Arthritis [Psa] in a Large, Integrated Health Plan: Demographics, Referral Patterns and Care Management [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/characterization-of-psoriatic-arthritis-psa-in-a-large-integrated-health-plan-demographics-referral-patterns-and-care-management/. Accessed December 7, 2019.
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