Provider Specialty and the Use of Disease‐Modifying Antirheumatic Drugs for Rheumatoid Arthritis Among Older Adults in the 2005‐2016 National Ambulatory Medical Care Survey

作者：Jiha Lee, Chiang‐Hua Chang, Raymond Yung, Julie Bynum · 发表于：ACR Open Rheumatology · 年份：2022 · DOI：10.1002/acr2.11406 · 被引用次数：12 · 研究领域：Rheumatoid Arthritis Research and Therapies、Medication Adherence and Compliance、Healthcare Systems and Reforms

OBJECTIVE: We compared disease-modifying antirheumatic drug (DMARD) use for older adults with rheumatoid arthritis (RA)-related ambulatory visits from rheumatologists and primary care providers (PCPs). METHODS: In this study of national sample office visits, we characterized ambulatory visits by older adults 65 years of age or older seen by rheumatologists or PCPs for diagnosis of RA using the 2005-2016 National Ambulatory Medical Care Survey. We analyzed patterns and trends of DMARD use using descriptive statistics and multivariable analyses by provider specialty. RESULTS: We identified 518 observations representing 7,873,246 ambulatory RA visits by older adults over 12 years; 74% were with rheumatologists. Any DMARD use was recorded at 56% of rheumatologist and 30% of PCP visits. Among visits with any DMARD use, 20% of rheumatologist visits had two or more DMARDs compared with 6% of PCP visits. Over the 12-year study period, there was no statistical difference in trend of any or conventional synthetic DMARD use at visits by provider specialty, adjusted for patient characteristics, non-DMARD polypharmacy and multimorbidity. However, biologic DMARD use was more likely to incrementally increase with rheumatologist compared with PCP visits (P = 0.003). CONCLUSION: DMARD use for older adults with RA remains low from both rheumatologists and PCPs, including biologic DMARDs, even though American College of Rheumatology guidelines recommend earlier and more aggressive treatment of ...