Receipt of DMARDs for RA among Medicare enrollees varies widely

Fewer than two-thirds of Medicare managed care patients with rheumatoid arthritis (RA) receive a disease-modifying antirheumatic drug (DMARD). There are wide variations in the receipt of DMARDs based on these patients’ sociodemographics, geographic location, and health plan, possibly resulting in disparities in outcomes.

Schmajuk and associates analyzed individual-level Healthcare Effectiveness Data and Information Set (HEDIS) information for 93,143 patients aged 65 years and older. The dependent variable was DMARD receipt; independent variables included age, race, sex, low personal income, and residence in a physician shortage county.

Among Medicare managed care enrollees with a diagnosis of RA, 63% received a DMARD. The largest difference in HEDIS performance was based on age; patients aged 85 years and older had a 30 percentage point lower rate of DMARD receipt than patients aged 65 to 69 years. Lower percentage point rates were found for men, black patients, patients with low personal income or low socioeconomic status, and patients enrolled in for-profit health plans. Performance by health plan varied from 16% to 87%.

The authors suggested that targeting educational and quality improvement interventions to patients who are underusing DMARDs and their clinicians will be important for eliminating the disparities.