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Use of Disease-modifying Antirheumatic Drugs for Inflammatory Arthritis in US Veterans: Effect of Specialty Care and Geographic Distance.

Authors
  • Walsh, Jessica A1, 2
  • Pei, Shaobo3, 4
  • Burningham, Zachary3, 4
  • Penmetsa, Gopi3, 4
  • Cannon, Grant W3, 4
  • Clegg, Daniel O3, 4
  • Sauer, Brian C3, 4
  • 1 From the Salt Lake City Veterans Affairs Medical Center and University of Utah School of Medicine, Department of Internal Medicine, Divisions of Rheumatology and Epidemiology, Salt Lake City, Utah. [email protected]
  • 2 J.A. Walsh, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; S. Pei, MS, Salt Lake City Veterans Affairs Medical Center and University of Utah; Z. Burningham, PhD, Salt Lake City Veterans Affairs Medical Center; G. Penmetsa, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; G.W. Cannon, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; D.O. Clegg, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; B.C. Sauer, PhD, Salt Lake City Veterans Affairs Medical Center and University of Utah. [email protected]
  • 3 From the Salt Lake City Veterans Affairs Medical Center and University of Utah School of Medicine, Department of Internal Medicine, Divisions of Rheumatology and Epidemiology, Salt Lake City, Utah.
  • 4 J.A. Walsh, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; S. Pei, MS, Salt Lake City Veterans Affairs Medical Center and University of Utah; Z. Burningham, PhD, Salt Lake City Veterans Affairs Medical Center; G. Penmetsa, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; G.W. Cannon, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; D.O. Clegg, MD, Salt Lake City Veterans Affairs Medical Center and University of Utah; B.C. Sauer, PhD, Salt Lake City Veterans Affairs Medical Center and University of Utah.
Type
Published Article
Journal
The Journal of rheumatology
Publication Date
Mar 01, 2018
Volume
45
Issue
3
Pages
430–436
Identifiers
DOI: 10.3899/jrheum.170554
PMID: 29142040
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To evaluate the effect of access to and distance from rheumatology care on the use of disease-modifying antirheumatic drugs (DMARD) in US veterans with inflammatory arthritis (IA). Provider encounters and DMARD dispensations for IA (rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) were evaluated in national Veterans Affairs (VA) datasets between January 1, 2015, and December 31, 2015. Among 12,589 veterans with IA, 23.5% saw a rheumatology provider. In the general IA population, 25.3% and 13.6% of veterans were exposed to a synthetic DMARD (sDMARD) and biologic DMARD (bDMARD), respectively. DMARD exposure was 2.6- to 3.4-fold higher in the subpopulation using rheumatology providers, compared to the general IA population. The distance between veterans' homes and the closest VA rheumatology site was < 40 miles (Near) for 55.9%, 40-99 miles (Intermediate) for 31.7%, and ≥ 100 miles (Far) for 12.4%. Veterans in the Intermediate and Far groups were less likely to see a rheumatology provider than veterans in the Near group (RR = 0.72 and RR = 0.49, respectively). Exposure to bDMARD was 34% less frequent in the Far group than the Near group. In the subpopulation who used rheumatology care, the bDMARD exposure discrepancy did not persist between distance groups. Use of rheumatology care and DMARD was low for veterans with IA. DMARD exposure was strongly associated with rheumatology care use. Veterans in the general IA population living far from rheumatology sites accessed rheumatology care and bDMARD less frequently than veterans living close to rheumatology sites.

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