Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Current ACR guidelines call for treatment of rheumatoid arthritis (RA) with non-biologic or biologic disease modifying anti-rheumatic drugs (DMARDs). The National Quality Forum has listed the prescribing of a DMARD as a specific measure of quality of care. This study seeks to evaluate regional variations in RA treatment and health outcomes.
Methods: Data were obtained from the 2012 U.S. National Health and Wellness Survey, a cross-sectional, self-administered, Internet-based survey of the general adult (aged 18+) population. Respondents reporting a diagnosis of RA (n=1088) were included in the analyses. Current treatments were obtained through a prompted list and categorized into a hierarchy: biologics; non-biologic DMARDs without biologics; other medication classes including steroids, opioids, and NSAIDS but without biologics or non-biologic DMARDs; untreated. Health outcomes included the SF-36v2, the Work Productivity and Activity Impairment (WPAI) questionnaire, and healthcare resource use in the previous six months.
Results: Variations in RA treatment are presented in the table. The Mountain region has the greatest use of biologic and non-biologic DMARDs (60%), as well as the greatest physical functioning (SF36v2 summary score 40.7), the least activity impairment (39%), and among the lowest proportion of ER (18%) and hospital use (11%). The East South Central region had the greatest proportion of patients who were untreated or undertreated with medications other than DMARDs (61%), while also having among the poorest mental and physical functioning (SF36v2 summary scores 43.3 and 38.0, respectively), the greatest activity impairment (52%), and the greatest proportion of ER (32%) and hospital use (22%).
Table: Current Treatment for RA within the U.S. Census Regions
|
|
Biologics |
Non-biologic DMARDs |
Other Medication Classes |
Untreated |
|
New England (n=36) |
28% |
14% |
39% |
19% |
|
Middle Atlantic (n=171) |
33% |
20% |
25% |
21% |
|
East North Central (n=191) |
25% |
27% |
29% |
18% |
|
West North Central (n=72) |
21% |
33% |
28% |
18% |
|
South Atlantic (n=238) |
28% |
24% |
29% |
18% |
|
East South Central (n=63) |
11% |
29% |
37% |
24% |
|
West South Central (n=104) |
38% |
18% |
25% |
17% |
|
Mountain (n=76) |
34% |
26% |
17% |
22% |
|
Pacific (n=137) |
39% |
18% |
25% |
19% |
Conclusion: These data suggest that there are regional variations in the care received by patients with RA in the U.S. as well as associated variations in patient outcomes. Initiatives to improve quality of care may benefit from a regional approach that considers these existing variations.
Disclosure:
S. C. Bolge,
Janssen Scientific Affairs, LLC,
3;
R. Meyer,
Janssen Scientific Affairs, LLC,
3;
K. Annunziata,
Janssen Scientific Affairs, LLC,
5.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/regional-variations-in-rheumatoid-arthritis-treatment-and-health-outcomes-across-the-united-states/