Factors associated with use of disease modifying agents for rheumatoid arthritis in the National Hospital and Ambulatory Medical Care Survey

doi:10.1016/j.semarthrit.2017.10.011

Seminars in Arthritis and Rheumatism

Volume 47, Issue 5, April 2018, Pages 649-653

https://doi.org/10.1016/j.semarthrit.2017.10.011 Get rights and content

Abstract

Objective

We examined the treatment patterns among adults with rheumatoid arthritis (RA) and identified factors influencing access to traditional and biological disease modifying antirheumatic drugs (DMARDs).

Methods

We analyzed visits recorded in the National Ambulatory Medical Care Survey from 2005 to 2014 with a RA diagnosis. The primary outcome was DMARD use (traditional and/or biological). We included prescriptions of all RA-related treatments such as traditional and biological DMARDs, glucocorticoids, gold preparations, immunosuppressants, and non-steroidal anti-inflammatory drugs. Covariates in the logistic regression models included age, gender, race/ethnicity, type of health care coverage, provider type, geographic region, and number of comorbidities.

Results

Among 1405 visits with a RA diagnosis, 60.4% (n = 807) were prescribed DMARDs and 23.8% (n = 334) biological DMARDs. In fully adjusted models, females have 1.57 times higher odds of any DMARD use (95% confidence interval (CI): 1.02–2.46). Also, Medicare beneficiaries as compared to privately insured have 2.31 times higher odds of receiving any DMARDs (95% CI: 1.40–3.82), while visits with specialist vs. general physician are 2.38 times more associated with any DMARD use (95% CI: 1.37–4.14). For biological DMARDs, Medicare beneficiaries were at 2.58 times higher odds (95% CI: 1.42–4.70) than privately insured, while visits with specialist are at 3.37 times higher odds than general physician (95% CI: 1.40–8.23).

Conclusion

Visits with a specialist and Medicare beneficiaries were significantly associated with any DMARD or biological DMARD use. Additionally, contrary to prior evidence, race/ethnicity was not associated with any DMARD or biological DMARD use, which may indicate reduction in disparity of treatment access.

Section snippets

Significance and innovations

•
The recent-most U.S. national survey of outpatient physician visit data shows that 76.8% visits among RA patients are associated with any DMARD use while 31.7% are associated with specifically biological DMARD use.
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Our results indicate that the type of insurance coverage and provider are significant indicators of RA treatment with traditional and biological DMARDs.
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Type of coverage may be a better indicator of DMARD treatment use than patient race/ethnicity and therefore, inadequate coverage may

Data source

The National Ambulatory Medical Care Survey (NAMCS) is a publicly available data collected through a national survey designed for information on the utilization and provision of ambulatory care services in hospital emergency and outpatient department visits. The data source is a nationally representative probability sample of office-based physician practices and outpatient settings across the US that uses a multistage cluster strategy to select physicians in hospital and outpatient settings by

Results

Among the total visits recorded over 2005–2014, n = 1405 were associated with RA. Among these the majority (76.3% [weighted]; n = 1092) were females and non-Hispanic White (74.9% [weighted]; n = 953). Additionally, 8.7% (weighted) (n = 243) were less than 45 years of age, 33.2% (weighted; n = 479) were 45 to <60 years of age, while 58% (weighted; n = 683) were 60 years or older. Overall, of the total treatment-related visits, 76.8% (n = 807) were associated with any DMARD use while 31.7% (n =

Discussion

Our assessment of factors associated with DMARD treatment using the recent-most available nationally representative data on outpatient physician visits yielded the following findings. First, a significantly higher distribution of males, visits in the Southern region, those with private insurance and three or more comorbidities were found among any DMARD-related visits while a significantly higher distribution of privately insured and age <45 years were found among bDMARD-related visits. Second,

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C.H. MacLean et al.
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Below is a detailed description of these studies (Table 1), organized based on their methods. Other studies not discussed here in detail can be found in our reference list.46–134 Two disparities studies stood out because of their broad consideration of economic determinants.
The number of biologics among new medication approvals is increasing. Social, political, and economic factors influence access to these expensive medications. Disparities in access to new medications can exacerbate health disparities. The notion of “structural determinants” provides a theoretical framework for broadly evaluating the integration of upstream social, political, and economic determinants in the clinical study of access.
To review the literature on access to FDA approved biologic medications with particular focus on the integration of social, political, and economic determinants into study design and interpretation.
We used PRISMA guidelines to review studies on racial and socioeconomic disparities in biologic access through August 2020. We assessed whether the design or interpretation of studies considered key economic determinants of access: the biologics supply chain, trade agreements, patents, drug research and development, insurance reimbursement, and non-insurance drug policies.
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2021, Journal of the National Medical Association
Background: Healthcare disparities negatively impact patient health outcomes; addressing disparities could improve quality of life and decrease overall healthcare cost. The National Ambulatory Medical Care Survey (NAMCS) is an objective and reliable source for collecting information on United States (U.S.) ambulatory medical care service visits and may be a useful tool for identifying potential disparities in care.
Objective: The purpose of this literature review is to describe studies utilizing NAMCS to capture U.S. healthcare disparities.
Methods: PubMed was searched for scientific articles that utilized NAMCS to determine health disparities in the U.S. The keywords queried included “NAMCS” or “National Ambulatory Medical Care Survey” and “disparity” or “disparities” as a pair or additionally paired with one of the following: “race”, “ethnicity”, “age”, “gender”, “geography”, or “insurance”.
Results: 66 studies were found that incorporated NAMCS data from 1980-2016 into their methods to measure outcomes relating to health disparities. Disparities were found in the following categories: race/ethnicity, geographic location, age, insurance type, gender, specialist care versus primary care, body habitus, and preexisting conditions affecting patient outcomes. Disparities were identified in pain management, neurology, dermatology, psychiatry, patient communication access, and non-specialty specific or primary care visits related to disease conditions, screening, and treatment plans.
Limitations: Only PubMed was utilized as a search engine and may not encompass all studies on NAMCS and health disparities. NAMCS is a cross-sectional database and does not allow for longitudinal analyses.
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Time to initiation of biologic disease-modifying antirheumatic drugs in the French cohort ESPOIR
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Évaluer le délai d’initiation d’une biothérapie au cours de la polyarthrite rhumatoïde (PR) dans la cohorte française ESPOIR, et évaluer les facteurs associés avec ce délai.
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These recommendations have led to an update of the therapeutic guidelines formulated by the French Society of Rheumatology (SFR), which are in France the reference for patient care [8]. The prescription of DMARDs has increased during the last decades [9], coinciding with the introduction of bDMARDs on the market. The first available TNF blockers were infliximab and etanercept in 2000, followed by adalimumab in 2003.
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: Funding: Priyanka Gaitonde, MS is supported as a Maryland CERSI scholar (FDA grant 1U01FD005946); Laura M. Bozzi, MS is funded by the NIA T32 AG00262

View full text

Factors associated with use of disease modifying agents for rheumatoid arthritis in the National Hospital and Ambulatory Medical Care Survey

Abstract

Objective

Methods

Results

Conclusion

Section snippets

Significance and innovations

Data source

Results

Discussion

2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

Arthritis Rheumatol

Quality of care for patients with rheumatoid arthritis

J Am Med Assoc

Use of disease‐modifying medications for rheumatoid arthritis by race and ethnicity in the National Ambulatory Medical Care Survey

Arthritis Care Res

Prescribing practices in a US cohort of rheumatoid arthritis patients before and after publication of the american college of rheumatology treatment recommendations

Arthritis Rheum