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Abstract Number: 279

Variations and Disparities in Healthcare Teams Among Individuals with Lupus

R. Paola Daly, Roushanac Partovi and Patricia Davidson, Lupus Foundation of America, Washington, DC

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Access to care and primary care

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Session Information

Date: Sunday, October 21, 2018

Title: Healthcare Disparities in Rheumatology Poster

Session Type: ACR Poster Session A

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

Background/Purpose:

Given the systemic and complex nature of lupus, individuals with lupus are often cared for by a multi-disciplinary team, each provider playing a unique role in lupus treatment, maintenance, or preventive healthcare. The purpose of this study is to analyze the composition of healthcare teams for individuals with lupus across demographic variables.

 

Methods:

This cross-sectional study draws from an online national needs assessment survey conducted between December 2015 and January 2016 among 3,022 adults who self-reported a lupus diagnosis. Respondents identified the type of healthcare providers who cared for their lupus and also the one provider who primarily treated their lupus. Multiple logistic regression models were conducted to assess the association between self-reported demographic information and treatment team composition. 

 

Results:

The majority of respondents (Table 1) had a rheumatologist primarily treating their lupus (78.6%), while a lower percentage reported a primary care provider (PCP) or nephrologist as their primary doctor for lupus (12.9% and 3.3%, respectively). Specific care team compositions emerged when analyzing what provider is primarily responsible for treating the individual’s lupus (Table 2). Groups with higher odds of having a rheumatologist in charge of their lupus care included: African Americans, females, and individuals with moderate or severe symptoms. Groups reporting higher odds of having a PCP in charge of their lupus care included rural respondents and respondents with public insurance. The analysis revealed that individuals whose symptoms were moderate to life threatening, who had public insurance and who were under 65 had higher odds of having a PCP on their treatment team. Significantly lower odds of having a PCP on the treatment team were observed among African American and Asian respondents.

 

Conclusion:

The study supports exploring whether rural respondents and individuals with public insurance are experiencing barriers to accessing specialty care. The study also highlights disparities among some minorities who are less likely to have a primary care provider on their care team. Considering the complexity of lupus and its comorbidities, ensuring access to both specialty and primary care is essential.  

 

Disclosure:

The Lupus Foundation of America received funding from UCB Pharma to support study data collection.

 

Table 1. Background characteristics of respondents (n = 3,022)*

Characteristic

No. (%)

Sex

 

Female

2823 (93.5)

Male

196 (6.5)

Geographic location

 

Rural

560 (18.6)

(Sub)urban

2446 (81.4)

Insurance

 

Private

1633 (65.7)

Medicaid/Medicare

851 (34.3)

Age

 

    Young adults (18-24)

81 (2.7)

    Adults (25-64)

2604 (86.2)

    Older adults (65-79)

337 (11.2)

Race/ethnicity

 

    White

1749 (57.9)

    African American

544 (18)

    Asian

90 (3)

    Latino

399 (13.2)

    Other races

240 (7.9)

Lupus treatment team

 

PCP on lupus treatment team

2178 (72.1)

PCP primarily treating

385 (12.9)

Nephrologist primarily treating

98 (3.3)

Rheumatologist primarily treating

2345 (78.6)

Symptom severity at diagnosis

 

    Mild

456 (15.2)

    Moderate

1114 (37.0)

    Severe

1036 (34.5)

    Life-threatening

401 (13.3)

* Individual items may not add to totals due to missing data.

 

Table 2. Logistic regression models of participant characteristics on treatment team composition

 

Model 1

 

Model 2

 

Model 3

 

Model 4

 

PCP on Treatment Team

 

Rheumatologist Primarily treating lupus

 

PCP Primarily treating lupus

 

Nephrologist Primarily treating lupus

 

OR (95% CI)

 

OR (95% CI)

 

OR (95% CI)

 

OR (95% CI)

Race§

 

 

 

 

 

 

 

African American

0.76 (0.59 – 0.97)*

 

1.43 (1.05 – 1.94)*

 

0.49 (0.33 – 0.75)†

 

1.84 (0.98 – 3.47)

Asian

0.43 (0.26 – 0.72)†

 

0.57 (0.32 – 1.00)

 

0.27 (0.07 – 1.12)

 

8.51 (3.81 – 18.99)‡

Latino

0.81 (0.61 – 1.08)

 

0.85 (0.63 – 1.16)

 

0.87 (0.58 – 1.30)

 

2.53 (1.32 – 4.85)†

Other races

1.19 (0.81 – 1.74)

 

0.93 (0.64 – 1.35)

 

1.10 (0.72 – 1.71)

 

1.28 (0.48 – 3.43)

Sex¶

 

 

 

 

 

 

 

Female

0.91 (0.61 – 1.34)

 

1.71 (1.18 – 2.49)†

 

0.85 (0.53 – 1.36)

 

0.82 (0.32 – 2.12)

Age group#

 

 

 

 

 

 

 

25-64 age group

1.94 (1.13 – 3.33)*

 

0.89 (0.44 – 1.80)

 

1.96 (0.60 – 6.39)

 

1.46 (0.34 – 6.32)

65+ age group

1.44 (0.78 – 2.67)

 

1.00 (0.47 – 2.15)

 

1.84 (0.54 – 6.30)

 

1.27 (0.24 – 6.71)

Location**

 

 

 

 

 

 

 

Rural

1.08 (0.84 – 1.39)

 

0.68 (0.53 – 0.87)†

 

1.70 (1.28 – 2.25)‡

 

0.76 (0.37 – 1.59)

Insurance††

 

 

 

 

 

 

 

Medicaid/Medicare

1.49 (1.19 – 1.87)‡

 

0.52 (0.41 – 0.65)‡

 

2.00 (1.52 – 2.64)‡

 

1.35 (0.80 – 2.26)

Symptom severity ‡‡

 

 

 

 

 

 

 

Moderate

1.34 (1.04 – 1.74)*

 

1.43 (1.07 – 1.92)*

 

0.88 (0.61 – 1.25)

 

0.34 (0.16 – 0.75)†

Severe

1.51 (1.16 – 1.98)†

 

1.38 (1.02 – 1.85)*

 

0.87 (0.61 – 1.26)

 

0.63 (0.32 – 1.25)

Life threatening

1.77 (1.26 – 2.49)†

 

1.29 (0.89 – 1.86)

 

0.51 (0.31 – 0.85)*

 

2.06 (1.07 – 3.98)*

* P < .05

† P < .01

‡ P < .001

§ Reference group is white.

¶ Reference group is male.

# Reference group is 18-24 age category.

** Reference group is suburban/urban.

†† Reference group is private insurance.

‡‡ Reference group is mild symptoms.

 


Disclosure: R. P. Daly, Lupus Foundation of America, 3; R. Partovi, Lupus Foundation of America, 3; P. Davidson, Lupus Foundation of America, 3.

To cite this abstract in AMA style:

Daly RP, Partovi R, Davidson P. Variations and Disparities in Healthcare Teams Among Individuals with Lupus [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/variations-and-disparities-in-healthcare-teams-among-individuals-with-lupus/. Accessed .
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