Patients with rheumatoid arthritis (RA) receive different care depending on where they live, and this has an impact on their outcomes, according to a study presented at the 2013 American College of Rheumatology (ACR) Meeting. Patients with RA who live in the Mountain region are treated according to ACR guidelines more often than patients who live in other regions of the United States.
In addition, these patients also have the best functionality, whereas patients living in the East South Central region are least likely to receive ACR guideline–recommended therapy, and have the worst functionality.
Senior investigator Kathy Annunziata, MA, Vice President, Research Services for Health Outcomes, Kantar Health, Princeton, NJ, and colleagues hope that this study, and others like it that reveal suboptimal regional variations in practice and outcomes, will stimulate new approaches that improve care in parts of the country where such improvement is warranted.
ACR guideline–recommended treatment for RA includes nonbiologic or biologic disease-modifying antirheumatic drugs (DMARDs). The investigators used data from the 2012 US National Health and Wellness Survey—a cross-sectional, self-administered, internet-based look at the general US adult population—and included 1088 respondents with a self-reported diagnosis of RA. Patients were asked to indicate their current treatments which were categorized as follows: biologics; nonbiologic DMARDs without biologics; other medication classes, including steroids, opioids, and nonsteroidal anti-inflammatory drugs but without biologics or nonbiologic DMARDs; and untreated. Outcomes were tallied according to the 36-item Short Form Health Survey, version 2 (SF-36v2), a widely used tool for assessing the health of general and specific populations; the Work Productivity and Activity Impairment (WPAI) questionnaire; and patients’ use of healthcare resources in the previous 6 months.
By census regions, the use of biologics or nonbiologic DMARDs was highest in the Mountain region (60%) and in the Pacific region (57%). Other regional uses of ACR guideline–recommended treatment were 56% in the West South Central region, 54% in the West North Central region, 53% in the Middle Atlantic region, 52% in the East North Central region and the South Atlantic, and lowest in New England (42%) and the East South Central region (40%). These last 2 regions also had the most undertreated patients—19% and 24%, respectively.
The East South Central region had not only the lowest adherence to ACR guideline–recommended treatment, but also was among the regions with the poorest physical and mental function, the most activity impairment, and the greatest proportionate use of the emergency department and hospital.
Self-identification of RA as “mild” was highest among patients in the Pacific region (32%). A “severe” rating was highest among patients in the West South Central (30%) and West North Central (28%) regions.
Although physical function was poor among patients with RA in every region of the United States, geographic variations were evident in patients’ mental function. Mean mental summary scores on the SF-36v2 ranged from a high of 47.0 in the West North Central region to a low of 43.3 in the East South Central region.
Employed patients with RA living in New England reported the least work impairment on the WPAI questionnaire (WPAI score, 21.0), whereas those residing in the East South Central and Pacific regions had the most work impairment (WPAI score, 31.6 and 53.0, respectively).