Session Title: Osteoarthritis - Clinical Aspects
Session Type: Abstract Submissions (ACR)
Background/Purpose: To compare current utilization of usual nonpharmacologic (NP) and pharmacologic (P) therapies for hand osteoarthritis (OA) by primary care providers (PCPs) and patients (Pts) based on American College of Rheumatology (ACR) 2012 Recommendations in 2 age- and gender-matched populations.
Methods: From voluntary in-home health visit (problem list, history, exam, medication reconciliation) with electronic health record assessment over 3 yrs for ascertainment of Medicare Advantage general health maintenance and quality benchmarking (Cty 1-Sacramento County CA, N = 50, and Cty 2-Cumberland County ME, N = 50), age- and gender-matched pts were identified. Pts were unaware the examiner was a rheumatologist. Discussion vs. Use vs. Source (PCP or pt) of NP recommendations (Activities of Daily Living, ADLs/Jt Protection/Assistive Device Provision for ADLs/Thermal Modalities/TrapezioMCP Splints) and P recs (Top. Capsaicin/Top. NSAIDs/PO NSAIDs/Tramadol) were queried. Descriptive statistics and/or SPlus were used where applicable: p value significance was = 0.05.
Results: Results: Behavior Risk Factor Surveillance System 2009/10 data confirmed no significant differences (nsd) from Cty 1 vs Cty 2 in: population (281,674 vs 265,012), % pop. > 65 (10.6 vs 11.2%), white ethnicity (78% vs 80%), female gender (70 vs 72%), mean age (72.4 vs 74.1 yrs-range 65-98), no. of pts. w/ doctor-diagnosed arthritis b/w ages of 65 and 74 (45 vs 53%), no. of pts. w/ activity limitation due to arthritis (48 vs 44%), no. of pts w/ social participation restriction due to arthritis (17 vs 14%), no. of pts w/ severe pain due to arthritis-non-site specified (27 vs 21%), obesity by BMI (32 vs 33%), the no. of Rheumatologists available for referral in network (6 vs 7), and the % of benchmarks attained for major health metrics (96 vs 95% capture). Latino ethnicity was statistically different (16.6 vs 1.9%). No significant differences from Cty 1 vs Cty 2 were noted for: Dx of OA-Hands (88 vs 92%); all had discussed OA as an issue with their PCPs at least once in the prior 3 yrs. Presence of hand OA was confirmed by Rheumatology exam in 88 vs 92% of pts. At least 1 NP Rec (Thermal Modalities) and 1 P Rec (Top NSAIDS) had been discussed at least once for all pts. by PCPs (100 vs 100%), but utilization was significantly different (44 vs 22%). Jt Protection and ADLs had not been discussed or utilized (80 vs 80%); only Assistive Device Provision (cane/walker) had been done (33 vs 30%). PO NSAIDs were actively discouraged even in low dose/Cox2 selective/H2 blocker usage by providers (80% vs 80%).
Current NP and P recommendations from OA experts are variably implemented with pts, despite confirmed presence of OA by their own PCPs as an Active Problem, and pts. reporting pain and social restriction due to arthritis.
G. A. McCarty,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/nonpharmacologic-and-pharmacologic-therapy-utilization-by-primary-care-providers-for-hand-osteoarthritis-comparative-review-by-electronic-health-record-data-mining-and-in-home-visit-verification/