Gaps in care for rheumatoid arthritis: A population study
Version of Record online: 7 APR 2005
Copyright © 2005 by the American College of Rheumatology
Arthritis Care & Research
Volume 53, Issue 2, pages 241–248, 15 April 2005
How to Cite
Lacaille, D., Anis, A. H., Guh, D. P. and Esdaile, J. M. (2005), Gaps in care for rheumatoid arthritis: A population study. Arthritis & Rheumatism, 53: 241–248. doi: 10.1002/art.21077
- Issue online: 7 APR 2005
- Version of Record online: 7 APR 2005
- Manuscript Accepted: 1 NOV 2004
- Manuscript Received: 9 AUG 2004
- Canadian Arthritis Network, one of the Federal Networks of Centres of Excellence. Grant Number: 03-MNO-03R
- New Investigator Salary Award from the Canadian Institute of Health Research
- The Arthritis Society of Canada
- Ministry of Health Services of British Columbia
- Treatment guidelines;
- Rheumatoid arthritis;
- Population study;
- Health services;
- Quality of care;
- Patterns of care;
- Health care
Treatment guidelines for rheumatoid arthritis (RA) now recommend early, aggressive, and persistent use of disease-modifying antirheumatic drugs (DMARDs) to prevent joint damage in all people with active inflammation, and evaluation by a rheumatologist, when possible. This research assesses whether care for RA, at a population level, is consistent with current treatment guidelines.
Using administrative billing data from the Ministry of Health in 1996–2000, all prevalent RA cases in British Columbia, Canada were identified. Data were obtained on all medications and all provincially-funded health care services.
We identified 27,710 RA cases, yielding a prevalence rate of 0.76%, consistent with epidemiologic studies. DMARD use was inappropriately low. Only 43% of the entire RA cohort received a DMARD at least once over 5 years, and 35% over 2 years. When used, DMARDs were started in a timely fashion, but were not used consistently. Care by a rheumatologist increased DMARD use 31-fold. Yet, only 48% and 34% saw a rheumatologist over 5 and 2 years, respectively. DMARD use was significantly more frequent, persistent, and more often used as combination therapy with continuous rheumatologist care. DMARDs were used by 84% and 73%, 40%, and 10% of people followed by rheumatologists continuously and intermittently, internists, and family physicians, respectively (P < 0.001). NSAID use, physiotherapy, and orthopedic surgeries were similar across these 4 care groups.
RA care in the British Columbia population was not consistent with current treatment guidelines. Efforts to educate family physicians and consumers about the shift in RA treatment paradigms and to improve access to rheumatologists are needed.