Session Information
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.
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Table 1. Background characteristics of respondents (n = 3,022)* |
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|
Characteristic |
No. (%) |
|
Sex |
|
|
Female |
2823 (93.5) |
|
Male |
196 (6.5) |
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Geographic location |
|
|
Rural |
560 (18.6) |
|
(Sub)urban |
2446 (81.4) |
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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) |
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Race/ethnicity |
|
|
White |
1749 (57.9) |
|
African American |
544 (18) |
|
Asian |
90 (3) |
|
Latino |
399 (13.2) |
|
Other races |
240 (7.9) |
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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) |
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Symptom severity at diagnosis |
|
|
Mild |
456 (15.2) |
|
Moderate |
1114 (37.0) |
|
Severe |
1036 (34.5) |
|
Life-threatening |
401 (13.3) |
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* Individual items may not add to totals due to missing data. |
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Table 2. Logistic regression models of participant characteristics on treatment team composition |
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Model 1 |
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Model 2 |
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Model 3 |
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Model 4 |
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|
PCP on Treatment Team |
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Rheumatologist Primarily treating lupus |
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PCP Primarily treating lupus |
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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¶ |
|
|
|
|
|
|
|
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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) |
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Age group# |
|
|
|
|
|
|
|
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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) |
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65+ age group |
1.44 (0.78 – 2.67) |
|
1.00 (0.47 – 2.15) |
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1.84 (0.54 – 6.30) |
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1.27 (0.24 – 6.71) |
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Location** |
|
|
|
|
|
|
|
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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) |
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Insurance†† |
|
|
|
|
|
|
|
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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) |
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Symptom severity ‡‡ |
|
|
|
|
|
|
|
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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)† |
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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)* |
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* 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. |
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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 .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/variations-and-disparities-in-healthcare-teams-among-individuals-with-lupus/