Gaps in care for rheumatoid arthritis: A population study
Gaps in care for rheumatoid arthritis: A population study
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DOI：
10.1002/art.21077
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发表时间：
2005-04-15
期刊：
影响因子：
--
通讯作者：
Esdaile, JM
中科院分区：
文献类型：
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作者：
Lacaille, D;Anis, AH;Esdaile, JM
Objective.类风湿性关节炎（RA）的治疗指南现在建议早期，积极和持续使用疾病缓解抗风湿药物（DMARDS），以防止所有活动性炎症患者的关节损伤，并在可能的情况下由风湿病学家进行评估。本研究评估了在人群水平上对RA的治疗是否符合当前的治疗指南。使用卫生部1996-2000年的行政账单数据，确定了加拿大不列颠哥伦比亚省所有流行的RA病例。所有药物和所有省级资助的医疗保健服务的数据。我们确定了27，710例RA病例，患病率为0.76%，与流行病学研究一致。DMARD的使用不适当地低。在整个RA队列中，只有43%的人在5年内至少接受过一次DMARD，35%的人在2年内接受过一次DMARD。当使用时，DMARD及时开始，但没有持续使用。风湿病学家的护理使DMARD的使用增加了31倍。然而，只有48%和34%的人分别在5年和2年内看过风湿病学家。DMARD的使用更频繁、更持久，更常作为联合治疗与持续的风湿病学家护理。风湿科医生、内科医生和家庭医生分别有84%和73%、40%和10%的人连续和间歇使用DMARDs（P < 0.001）。NSAID的使用、物理治疗和骨科手术在这4个治疗组中相似。RA护理在不列颠哥伦比亚省人口不符合目前的治疗指南。需要努力教育家庭医生和消费者关于RA治疗模式的转变，并改善获得风湿病学家的机会。
Objective. 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.Methods. 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.Results. 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.Conclusion. 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.