Various organizations can be enlisted to help obtain affordable medical care for this patient, although they may only provide a partial solution to the problem or may only be able to help certain patients. Just how far you are willing to go is a matter of personal choice and belief. Nonetheless, given the inconsistent availability of care, the expense of current therapy, and the chronic nature of rheumatic disease, such problems are likely to remain part of the landscape in rheumatic disease care for the foreseeable future. In a previous issue we discussed that even treating a patient with methotrexate without the ability to monitor blood work is problematic (July 2010, p. 1). As is typical of many problems, the solutions are not obvious or easy.
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Dr. Meltzer is assistant professor of medicine at Thomas Jefferson University in Philadelphia. Dr. MacKenzie is associate professor of clinical medicine and public health at Weill Cornell Medical College, Hospital for Special Surgery in New York. Dr. Kitsis is director of bioethics education and a member of the rheumatology division at Albert Einstein College Medicine in the Bronx, N.Y.
- American College of Rheumatology. The Future of Health Care in the United States. February 2009. Available at www.rheumatology.org/advocacy/acr_future_ of_health_care_usa.pdf. Accessed May 2, 2011.
- Schmajuk G, Trivedi AN, Solomon DH, et al. Receipt of disease-modifying antirheumatic drugs among patients with rheumatoid arthritis in medicare managed care plans. JAMA. 2011;305:480-486.