Receipt of glucocorticoid monotherapy among Medicare beneficiaries with rheumatoid arthritis.
Receipt of glucocorticoid monotherapy among Medicare beneficiaries with rheumatoid arthritis.
复制标题
患有类风湿性关节炎的医疗保险受益人接受糖皮质激素单一疗法。
DOI：
10.1002/acr.22312
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发表时间：
2014
影响因子：
4.7
通讯作者：
Trivedi,AmalN
中科院分区：
文献类型：
--
作者：
Yazdany,Jinoos;Tonner,Chris;Schmajuk,Gabriela;Lin,GraceA;Trivedi,AmalN
目的：使用疾病修饰抗风湿药物（DMARDs）改善类风湿关节炎（RA）的预后，是一项国家认可的质量措施。我们在全国范围内的医疗保险受益人样本中调查了单独接受糖皮质激素治疗RA的患病率和预测因素。方法：在2009年参加D部分处方药福利的年龄≥65岁的RA患者中，我们比较了DMARD索赔≥1的患者和接受糖皮质激素单药治疗的患者，定义为无DMARD索赔，年糖皮质激素供应≥180天或年剂量≥900 mg泼尼松或同等药物。我们拟合多变量模型来确定与糖皮质激素单药治疗相关的社会人口统计学和临床因素。结果在8125名RA患者中，10.2% （n = 825）单独接受糖皮质激素治疗。低收入的受益人更有可能单独接受糖皮质激素治疗（12.3%；95%置信区间[95% CI] 10.9-13.8%对9.4%;95% CI 8.6-10.1%），生活在美国某些地区的人也是如此。更多的医生办公室就诊和住院与糖皮质激素单药治疗有关。未与风湿病医生接触的个体更有可能单独接受糖皮质激素治疗（17.5%;95% CI 16.0-19.0% vs 8.5%; 95% CI 7.4-9.5%，未与1-4次风湿病医生接触的个体）。结论：2009年，大约十分之一的医疗保险受益人接受了无DMARDs的糖皮质激素治疗。与DMARD使用者相比，糖皮质激素使用者年龄较大，收入较低，更有可能生活在美国某些地区，并且不太可能看过风湿病专家，这表明尽管D部分扩大了药物覆盖范围，但护理质量仍然存在差距。
ObjectiveUsing disease‐modifying antirheumatic drugs (DMARDs) improves outcomes in rheumatoid arthritis (RA) and is a nationally endorsed quality measure. We investigated the prevalence and predictors of receiving glucocorticoids alone for the treatment of RA in a nationwide sample of Medicare beneficiaries.MethodsAmong individuals ages ≥65 years with RA enrolled in the Part D prescription drug benefit in 2009, we compared those with ≥1 DMARD claim to those receiving glucocorticoid monotherapy, defined as no DMARD claim and an annual glucocorticoid supply of ≥180 days or an annual dose of ≥900 mg of prednisone or equivalent. We fit multivariable models to determine the sociodemographic and clinical factors associated with glucocorticoid monotherapy.ResultsOf 8,125 beneficiaries treated for RA, 10.2% (n = 825) received glucocorticoids alone. Beneficiaries with low incomes were more likely to receive glucocorticoids alone (12.3%; 95% confidence interval [95% CI] 10.9–13.8% versus 9.4%; 95% CI 8.6–10.1%), as were those living in certain US regions. More physician office visits and hospitalizations were associated with glucocorticoid monotherapy. Individuals who had no contact with a rheumatologist were significantly more likely to receive glucocorticoids alone (17.5%; 95% CI 16.0–19.0% versus 8.5%; 95% CI 7.4–9.5% for those with no rheumatology visits versus 1–4 visits).ConclusionApproximately 1 in 10 Medicare beneficiaries treated for RA received glucocorticoids without DMARDs in 2009. Compared to DMARD users, glucocorticoid users were older, had lower incomes, were more likely to live in certain US regions, and were less likely to have seen a rheumatologist, suggesting persistent gaps in quality of care despite expanded drug coverage under Part D.