“At this point, I think it’s important to recognize the potential links between oral health status and overall health status,” said Dr. Mikuls. “Although it’s clearly premature to suggest that treating gum disease prevents or even improves RA, it’s likely that this will be explored in the near future.”
Quality of Care in RA
Gabriela Schmajuk, MD, MS, assistant professor of medicine at the University of California, San Francisco School of Medicine, summarized findings from a 2011 study that first assessed the use of DMARDs in a nationally representative sample of U.S. patients with RA. Using data from Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare managed care plans, the study found that one-third of Medicare managed care beneficiaries with RA were not receiving DMARD therapy, along with wide variations in beneficiaries who were receiving DMARD therapy, including variations in age, sex, race, geography, health professional shortage areas, and health-plan profit status. For example, lower rates of DMARD use were found in patients who were nonwhite, had lower personal income, lived in the South Atlantic states, and were covered by for-profit health plans.
She then focused her talk on a new analysis done to address the limitations of the first study. These limitations included the inability to assess clinical status, comorbidities, specific drug used, or treating physician; the potential for misclassification of RA diagnosis used within the HEDIS reporting system; and the inability to assess allowances on prescription drug benefits for each health plan.
In the new Medicare fee-for-service analysis, she and her colleagues looked at a sample of 12,634 Medicare fee-for-service patients from 2009. All patients were at least 65 years old with at least two codes for a diagnosis of RA, and enrolled in Part D of Medicare. In addition, data were collected on drug name and dose received, comorbid conditions, and heath provider data. For this analysis, instead of comparing whether people received a DMARD or not, the investigators compared patients with at least one claim for any DMARD with those receiving glucocorticoid monotherapy (>180 day supply or 900 mg of prednisone within a year). The study found that 58% of the 12,634 patients received any DMARD, and that 10% of RA patients received significant doses of steroids alone. Of these latter patients, low-income patients were more likely to receive steroids alone, as were patients without contact with a rheumatologist. Characterizing the finding as “breathtaking,” Dr. Schmajuk said the study found that over 30% of low-income patients with no contact with a rheumatologist received steroids alone. Overall, she said that the Medicare fee-for-service analysis extends and confirms the work of the first study using HEDIS data.
