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Regional and temporal variation in the treatment of rheumatoid arthritis across the UK: a descriptive register-based cohort study

Regional and temporal variation in the treatment of rheumatoid arthritis across the UK: a descriptive register-based cohort study
Regional and temporal variation in the treatment of rheumatoid arthritis across the UK: a descriptive register-based cohort study
Objectives: to describe current disease-modifying antirheumatic drugs (DMARDs) prescription in rheumatoid arthritis (RA) with reference to best practice and to identify temporal and regional trends in the UK.

Design: descriptive, register-based cohort study.

Participants: permanently registered patients aged ?18 years with a recorded diagnosis of RA between 1 January 1995 and 31 March 2010 and matched controls. Participants with RA were identified through screening of all patients in the General Practice Research Database (GPRD) with a clinical or referral record for RA and at least 1 day of follow-up.

Setting: 639 general practices in the UK supplying data to the GPRD.

Main outcomes measures: medication prescribing between 3 and 12 months of RA diagnosis by region and time period (1995-1999, 2000-2005 and 2006-April 2010).

Results: of the 35 911 patients in the full RA cohort, 15 259 patients (42%) had incident RA. Analysis of prescribing in incident RA patients demonstrated that between 1995 (baseline) and 2010 there was a substantial increase in DMARD, and specifically methotrexate, prescribing across all regions with a less marked increase in combination DMARD prescribing. Taking 12-month prescribing as a snapshot: DMARD prescribing was 19-49% at baseline increasing to 45-74% by 2006-April 2010; methotrexate prescribing was 4-16% at baseline increasing to 32-60%; combination DMARD prescribing was 0-8% at baseline increasing to 3-17%. However, there was marked regional variation in the proportion of RA patients receiving DMARD regardless of time period.

Conclusions: there has been a substantial increase in prescribing of DMARDs for RA since 1995; however, regional variation persists across the UK with relative undertreatment, according to established best practice. Improved implementation of evidence-based best clinical practice to facilitate removal of treatment variation is warranted. This may occur as a result of the implementation of published national guidance

Edwards, C.J.
dcb27fec-75ea-4575-a844-3588bcf14106
Campbell, J.
d38acff7-94df-4466-b716-fcb647155b8f
van Staa, T.
7e263d59-ecc2-41f2-8b20-3f934d09c2c9
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f
Edwards, C.J.
dcb27fec-75ea-4575-a844-3588bcf14106
Campbell, J.
d38acff7-94df-4466-b716-fcb647155b8f
van Staa, T.
7e263d59-ecc2-41f2-8b20-3f934d09c2c9
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f

Edwards, C.J., Campbell, J., van Staa, T. and Arden, N.K. (2012) Regional and temporal variation in the treatment of rheumatoid arthritis across the UK: a descriptive register-based cohort study. BMJ Open, 2 (6). (doi:10.1136/bmjopen-2012-001603). (PMID:23144258)

Record type: Article

Abstract

Objectives: to describe current disease-modifying antirheumatic drugs (DMARDs) prescription in rheumatoid arthritis (RA) with reference to best practice and to identify temporal and regional trends in the UK.

Design: descriptive, register-based cohort study.

Participants: permanently registered patients aged ?18 years with a recorded diagnosis of RA between 1 January 1995 and 31 March 2010 and matched controls. Participants with RA were identified through screening of all patients in the General Practice Research Database (GPRD) with a clinical or referral record for RA and at least 1 day of follow-up.

Setting: 639 general practices in the UK supplying data to the GPRD.

Main outcomes measures: medication prescribing between 3 and 12 months of RA diagnosis by region and time period (1995-1999, 2000-2005 and 2006-April 2010).

Results: of the 35 911 patients in the full RA cohort, 15 259 patients (42%) had incident RA. Analysis of prescribing in incident RA patients demonstrated that between 1995 (baseline) and 2010 there was a substantial increase in DMARD, and specifically methotrexate, prescribing across all regions with a less marked increase in combination DMARD prescribing. Taking 12-month prescribing as a snapshot: DMARD prescribing was 19-49% at baseline increasing to 45-74% by 2006-April 2010; methotrexate prescribing was 4-16% at baseline increasing to 32-60%; combination DMARD prescribing was 0-8% at baseline increasing to 3-17%. However, there was marked regional variation in the proportion of RA patients receiving DMARD regardless of time period.

Conclusions: there has been a substantial increase in prescribing of DMARDs for RA since 1995; however, regional variation persists across the UK with relative undertreatment, according to established best practice. Improved implementation of evidence-based best clinical practice to facilitate removal of treatment variation is warranted. This may occur as a result of the implementation of published national guidance

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Published date: 2012
Organisations: Faculty of Medicine

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Local EPrints ID: 351937
URI: http://eprints.soton.ac.uk/id/eprint/351937
PURE UUID: 7c140c2f-78ba-415a-a1a2-0d4b0c022059

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Date deposited: 29 Apr 2013 10:56
Last modified: 16 Jul 2019 21:35

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Contributors

Author: C.J. Edwards
Author: J. Campbell
Author: T. van Staa
Author: N.K. Arden

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