Identifying factors associated with concordance with the American College of Rheumatology rheumatoid arthritis treatment recommendations
Authors
Harrold, Leslie R.Reed, George
Kremer, Joel
Curtis, Jeffrey R.
Solomon, Daniel H.
Hochberg, Marc
Kavanaugh, Arthur
Saunders, Katherine C.
Shan, Ying
Spruill, Tanya M.
Pappas, Dimitrios A.
Greenberg, Jeffrey D.
UMass Chan Affiliations
Department of Orthopedics and Physical RehabilitationDocument Type
Journal ArticlePublication Date
2016-04-26Keywords
American College of RheumatologyDisease-modifying antirheumatic drugs
Rheumatoid arthritis
Musculoskeletal Diseases
Orthopedics
Rheumatology
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BACKGROUND: Factors associated with care concordant with the American College of Rheumatology (ACR) recommendations for the use of disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) are unknown. METHODS: We identified a national cohort of biologic-naive patients with RA with visits between December 2008 and February 2013. Treatment acceleration (initiation or dose escalation of biologic and nonbiologic DMARDs) in response to moderate to high disease activity (using the Clinical Disease Activity Index) was assessed. The population was divided into two subcohorts: (1) methotrexate (MTX)-only users and (2) multiple nonbiologic DMARD users. In both subcohorts, we compared the characteristics of patients who received care consistent with the ACR recommendations (e.g., prescriptions for treatment acceleration) and their providers with the characteristics of those who did not at the conclusion of one visit and over two visits, using logistic regression and adjusting for clustering of patients by rheumatologist. RESULTS: Our study included 741 MTX monotherapy and 995 multiple nonbiologic DMARD users cared for by 139 providers. Only 36.2 % of MTX monotherapy users and 39.6 % of multiple nonbiologic DMARD users received care consistent with the recommendations after one visit, which increased over two visits to 78.3 % and 76.2 %, respectively (25-30 % achieved low disease activity by the second visit without DMARD acceleration). Increasing time since the ACR publication on RA treatment recommendations was not associated with improved adherence. CONCLUSIONS: Allowing two encounters for treatment acceleration was associated with an increase in care concordant with the recommendations; however, time since publication was not.Source
Arthritis Res Ther. 2016 Apr 26;18:94. doi: 10.1186/s13075-016-0992-3. Link to article on publisher's site
DOI
10.1186/s13075-016-0992-3Permanent Link to this Item
http://hdl.handle.net/20.500.14038/40047PubMed ID
27118040Related Resources
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Copyright © Harrold et al. 2016. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Distribution License
http://creativecommons.org/licenses/by/4.0/ae974a485f413a2113503eed53cd6c53
10.1186/s13075-016-0992-3
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Except where otherwise noted, this item's license is described as Copyright © Harrold et al. 2016. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.