(Press-News.org) An analysis of data from more than 90,000 Medicare managed care enrollees who received care for rheumatoid arthritis finds that more than one-third did not receive the recommended treatment with a disease-modifying antirheumatic drug, and that receipt varied by demographic factors, socioeconomic status, geographic location and health plan, according to a study in the February 2 issue of JAMA.
Despite evidence-based guidelines recommending early and aggressive treatment of active rheumatoid arthritis (RA), recent population-based studies of disease-modifying antirheumatic drug (DMARD) receipt in patients with RA report low rates of use, although these data may not be broadly generalizable because of several limitations. In 2005, the Healthcare Effectiveness Data and Information Set (HEDIS) introduced a quality measure to assess the receipt of DMARDs among patients with rheumatoid arthritis, according to background information in the article. HEDIS data from Medicare managed care plans provide a nationally representative sample of the managed care population older than 65 years.
Gabriela Schmajuk, M.D., M.S., of Stanford University, Stanford, Calif., and colleagues examined sociodemographic, community, and health plan factors associated with DMARD receipt among Medicare managed care enrollees. The researchers analyzed HEDIS data for 93,143 patients who were at least 65 years old with at least 2 diagnoses of RA within a year (during 2005-2008). The average age of patients was 74 years; 75 percent were women and 82 percent were white.
Overall performance on the HEDIS measure for RA in the study sample was 63 percent. In 2005, 59 percent of the sample received a DMARD, increasing to 67 percent in 2008. The largest difference in performance on the HEDIS RA measure was based on age: participants 85 years and older had a 30 percentage point lower rate of DMARD receipt compared with patients 65 to 69 years old. Other participant categories less likely to receive a DMARD were men, individuals identified by race as black or other, individuals with low personal income, participants in lower socioeconomic status zip codes, and individuals in the Middle and South Atlantic regions.
"Patients living in a health professional shortage area had slightly lower performance (-3 percentage points). In addition, patients enrolled in a for-profit health plan had a 4 percentage point lower rate of DMARD receipt compared with patients enrolled in a not-for-profit health plan," the authors write. Performance varied widely by health plan, with rates ranging from 16 percent to 87 percent.
The researchers write that although RA was once an inevitably deforming and disabling condition, the development of new DMARDs and support for their early use has dramatically improved clinical outcomes for many patients. "This study suggests that 1 mechanism for the sociodemographic disparities in RA outcomes in the United States may relate to differences in DMARD receipt."
"Given the enormous individual and societal costs associated with RA, and increasing substantial evidence that DMARDs can reduce these costs, variations in DMARD receipt based on demographics, socioeconomic status, and geography are unacceptable. Because optimizing DMARD use is the primary mechanism for decreasing the significant public health impact of RA in the United States, targeting educational and quality improvement interventions to patients who are underusing DMARDs and their clinicians will be important to eliminate these disparities. Additional studies of population-wide cohorts that include clinical data and disease activity measures are needed to validate our findings."
###
(JAMA. 2011;305[5]:480-486. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Please Note: For this study, there will be multimedia content available, including the JAMA Report video, embedded and downloadable video, audio files, text, documents, and related links. This content will be available at 3 p.m. CT Tuesday, February 1 at this link.
To contact Gabriela Schmajuk, M.D., M.S., call Tracie White at 650-723-7628 or email tracie.white@stanford.edu.
For More Information: Contact the JAMA/Archives Media Relations Department at 312-464-JAMA or email: mediarelations@jama-archives.org.
END
SALT LAKE CITY—As day-old embryos, fruit flies called Drosophila enter a stage in which their cells freely divide and proliferate as the insect grows dramatically in size.
This is true for all animals, which undergo most of their growth prior to sexual maturation. Until now, researchers have known nothing about the metabolic state that occurs when cells divide during early development. But in a study published online Tuesday, Feb. 1, 2011, in Cell Metabolism, University of Utah human genetics researchers show that this cell division in Drosophila depends on a metabolic ...
PHILADELPHIA—Medical physicists at Thomas Jefferson University and Jefferson's Kimmel Cancer Center have demonstrated a new real-time tumor tracking technique that can help minimize the amount of radiation delivered to surrounding healthy tissue in a patient—up to 50 percent less in some cases—and maximize the dose the tumor receives.
Respiratory and cardiac motions have been found to displace and deform tumors in the lung, pancreas, liver, breast, and other organs. Because of this, radiation oncologists must expand the margin during radiotherapy. Consequently, a large ...
BOSTON – For-profit hospice agencies had a higher percentage of patients with diagnoses associated with less skilled care and longer lengths of stay (LOS) in hospice, than their nonprofit counterparts, a difference that may leave "nonprofit hospice agencies disproportionately caring for the most costly patients," Beth Israel Deaconess Medical Center researchers report.
The findings appear in the Feb.2 issue of the Journal of the American Medical Association (JAMA).
"There was a big increase in the number of for-profit hospice agencies from 2000 to 2007, and previous ...
As Internet authorities prepare to announce that they have handed over all of the available addresses, a USC research group that monitors address usage has completed the latest in its series of Internet censuses.
There is some good news, according to computer scientist John Heideman, who heads a team at the USC Viterbi School of Engineering Information Sciences Institute that has just released its results in the form of a detailed outline, including a 10-minute video and an interactive web browser that allows users to explore the nooks and crannies of Internet space themselves.
video: ...
"Look to the ant thou sluggard and consider her ways and be wise." This proverbial wisdom was taken to heart recently by an international group of ant experts who have published the genome sequences of four ants in a series of coordinated releases in the journal Proceedings of the National Academy of Sciences (PNAS). The quartet includes the genomes of the red harvester ant Pogonomyrmex barbatus; the Argentine ant Linepithema humile; the fire ant Solenopsis invicta, and the leaf-cutter ant Atta cephalotes, whose genome will be published on Feb. 10 in Public Library of Science ...
In a global recession, most people are thankful to have a job, but a new study published in Interdisciplinary Environmental Review suggests that employees are more likely to be satisfied with their jobs if they are working for a company that is perceived to be "green", whereas the financial performance of companies fails to correlate with employee happiness.
Cassandra Walsh and Adam Sulkowski, both of the Charlton College of Business at University of Massachusetts Dartmouth, wanted to know whether employee morale is typically affected when a company is perceived as taking ...
Researchers from the Institute of Biotechnology and Biomedicine and the UAB Department of Biochemistry and Molecular Biology have developed and patented a method using Saccharomyces cerevisiae yeast to detect in human proteins the formation of oligomers, small toxic aggregations of molecules which can initiate the assembly of amyloid fibres found in neurodegenerative diseases. The test allows validating the efficacy of compounds which could dissolve or inhibit these aggregates, as well as studying at basic level the therapeutic potentiality of a large number of molecules. ...
Invasive plant species present a serious environmental, economic and social problem worldwide as their abundance can lead to lost native biodiversity and ecosystem functions, such as nutrient cycling. Despite substantial research, little is known about why some species can dominate new habitats over native plants that technically should have the advantage.
A common but rarely tested assumption is that these plants are more abundant in introduced versus native communities, because they are behaving in special way. If this true and introduced species are behaving in a special ...
Philadelphia, PA, 1 February 2011 - Opiate abuse is a chronic disorder and maintaining abstinence represents a major challenge for addicts.
Individuals recovering from opiate dependence have long reported that while the acute withdrawal symptoms from opiates may pass relatively quickly, they do not feel quite right for several weeks or even months thereafter. Called the "protracted abstinence syndrome," this cluster of vague depressive-like symptoms can include reduced concentration, low energy level, poor sleep quality, and anhedonia.
New data in animals, reported ...
Researchers funded by the Biotechnology and Biological Sciences Research Council (BBSRC) have revealed a novel molecular mechanism that triggers plant infection by Pseudomonas syringae, the bacteria responsible for bacterial speck in tomatoes. The scientists from the Department of Life Sciences at Imperial College London have revealed how two genes in the bacteria work together to launch the infection process that ultimately kills the plant's cells and causes disease, significantly reducing crop quality and yield.
Pseudomonas syringae is responsible for major disease ...
