Impact of managed care health insurance system for indigent patients with rheumatoid arthritis in Puerto Rico

Santiago-Casas, Yesenia; Gonzalez‐Rivera, Tania; Castro-Santana, Lesliane E.; Ríos, Grissel; Martı́nez, David; González-Alcover, Rafael; Mayor, Ángel M.; Vilá, Luis M.

doi:10.1007/s10067-013-2167-9

Cited by 3 publications

(7 citation statements)

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“…Previous studies have provided evidence of disparities in RA treatment in the Puerto Rican population [9,10]. A cross-sectional study of Puerto Ricans with RA looked at disparities between those receiving their healthcare in a managed care system (n = 67) and non-indigent patients treated in fee-for-service settings (n = 147) [10]. Patients in the managed care setting had more joint deformities, extra-articular manifestations, arterial hypertension, type Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Although arthritis is one of the most prevalent health conditions in Puerto Rico [8], few studies have been conducted in Puerto Rican or Hispanic populations specifically [9][10][11]. Studies in the broader US population have identified some racial and ethnic disparities, reporting higher levels of disease activity and worse functional status in Hispanic patients compared with white patients, although it is not clear why this is the case [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Studies in the broader US population have identified some racial and ethnic disparities, reporting higher levels of disease activity and worse functional status in Hispanic patients compared with white patients, although it is not clear why this is the case [12][13][14]. Several studies have found that starting b/tsDMARD treatment early in the disease course (within 12 months of initial symptoms) improves long-term outcomes in RA, and this has been confirmed in the Puerto Rican population [10]. However, little is known about the patient characteristics or patterns of treatment among people receiving b/tsDMARD treatment for RA in Puerto Rico.…”

Section: Introductionmentioning

confidence: 99%

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Treatment Patterns Among Patients with Rheumatoid Arthritis in Puerto Rico

et al. 2022

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Introduction: Racial and ethnic disparities in rheumatoid arthritis (RA) have been identified in the United States, with higher levels of disease activity and worse functional status reported in Hispanic patients compared with their white counterparts. Although RA is one of the most prevalent health conditions in Puerto Rico, few studies have previously examined the characteristics or treatment patterns of patients receiving biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/ tsDMARDs) in this population. Methods: This was a retrospective cohort study using data extracted from the Advanced Business Management Organization database, which represents around 70% of pharmacy claims in Puerto Rico. Patients with RA were included if they had C 1 prescription for any approved b/tsDMARD during the index period (January 2016 to July 2018), and C 2 years of follow-up. The objective was to describe and compare the demographic and clinical characteristics of patients with RA being treated with b/tsDMARD therapy in Puerto Rico, and to evaluate the treatment patterns among these patients.Results: Most patients (74%) received tumor necrosis factor inhibitors (TNFis) as index therapy, followed by abatacept (17%), Janus kinase inhibitors (JAKis; 5%), and other non-TNFis (4%). Similar trends were observed in subsequent lines of therapy, although abatacept was more frequently used in these later lines versus index therapy. At 2 years, 62% of patients had discontinued their index therapy and 17% had switched to an alternative b/tsDMARD; only 21% persisted with index therapy. The percentage of patients who were persistent with their index therapy at the end of year 2 was 28% for JAKis, 36% for abatacept, 41% for TNFis, and 45% for other non-TNFis. Conclusions: These findings demonstrate that despite the availability of several b/tsDMARDs, patients with RA in Puerto Rico still experience substantial treatment disruption, with almost two-thirds of patients discontinuing their index therapy within 2 years.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment Patterns Among Patients with Rheumatoid Arthritis in Puerto Rico

et al. 2022

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“…Our cohort of RA patients has been described in detail before [ 12 , 13 ]. In short, all patients met the 1987 ACR classification criteria for RA [ 14 ] and had Puerto Rican ethnicity.…”

Section: Methodsmentioning

confidence: 99%

“…As described before, our database comprises variables from the demographic, health-related behaviors, clinical, and pharmacologic domains [ 12 , 13 ]. Demographic features and health-related behaviors included age (at study visit), sex, disease duration (time interval between RA onset and study visit), and current status (within the past 30 days) of cigarette smoking, alcohol consumption and exercise.…”

Section: Methodsmentioning

confidence: 99%

Long-Term Outcomes in Puerto Ricans with Rheumatoid Arthritis (RA) Receiving Early Treatment with Disease-Modifying Anti-Rheumatic Drugs using the American College of Rheumatology Definition of Early RA

Varela-Rosario¹,

Arroyo-Ávila²,

Fred-Jiménez³

et al. 2017

TORJ

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Background:Early treatment of rheumatoid arthritis (RA) results in better long-term outcomes. However, the optimal therapeutic window has not been clearly established.Objective:To determine the clinical outcome of Puerto Ricans with RA receiving early treatment with conventional and/or biologic disease-modifying anti-rheumatic drugs (DMARDs) based on the American College of Rheumatology (ACR) definition of early RA.Methods:A cross-sectional study was performed in a cohort of Puerto Ricans with RA. Demographic features, clinical manifestations, disease activity, functional status, and pharmacotherapy were determined. Early treatment was defined as the initiation of DMARDs (conventional and/or biologic) in less than 6 months from the onset of symptoms attributable to RA. Patients who received early (< 6months) and late (≥6 months) treatments were compared using bivariate and multivariate analyses.Results:The cohort comprised 387 RA patients. The mean age at study visit was 56.0 years. The mean disease duration was 14.9 years and 337 (87.0%) patients were women. One hundred and twenty one (31.3%) patients received early treatment. In the multivariate analysis adjusted for age and sex, early treatment was associated with better functional status, lower probability of joint deformities, intra-articular injections and joint replacement surgeries, and lower scores in the physician’s assessments of global health, functional impairment and physical damage of patients.Conclusion:Using the ACR definition of early RA, this group of patients treated with DMARDs within 6 months of disease had better long-term outcomes with less physical damage and functional impairment.

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Use of adjuvant chemotherapy in patients with stage III colon cancer in Puerto Rico: A population-based study

et al. 2018

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ObjectiveThis study aims to examine factors associated with the use of adjuvant chemotherapy and the use of oxaliplatin after curative resection in stage III colon cancer patients and assesses the effect of their use in three-year survival.MethodsThis retrospective cohort study was conducted using Puerto Rico Central Cancer Registry-Health Insurance Linkage Database. The study cohort consisted of stage III colon cancer patients with a curative surgery in the period 2008–2012. Multivariate logistic regression was used to estimate adjusted odds ratios. Kaplan-Meier methods and Cox proportional hazards models were used to assess the association between adjuvant chemotherapy and oxaliplatin use and overall survival and risk of death, respectively.ResultsOverall, 75% of the study population received adjuvant chemotherapy during the study period. Factors statistically associated with receiving adjuvant chemotherapy within four months after resection included being married (adjusted odds ratio [AOR] 1.64; 95% CI 1.18–2.28; p = 0.003), and being enrolled in Medicare (AOR 1.68; 95% CI: 1.03–2.75; p = 0.039) or Medicaid and Medicare dual eligible (AOR 1.66; 95% CI: 1.06–2.60; p = 0.028). However, patients aged ≥70 years were less likely to receive adjuvant chemotherapy (AOR 0.22; 95%CI 0.14–0.36; p<0.001).DiscussionWe observed a significant reduction in mortality in adjuvant chemotherapy treated patients. Similarly, patients <70 years treated with oxaliplatin had significantly lower risk of death than those who did not, although for patients ≥70 years no statistical significance was achieved. Future studies should assess effective interventions to reduce barriers to access guideline-based recommended colon cancer treatment.

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Impact of managed care health insurance system for indigent patients with rheumatoid arthritis in Puerto Rico

Cited by 3 publications

References 25 publications

Treatment Patterns Among Patients with Rheumatoid Arthritis in Puerto Rico

Treatment Patterns Among Patients with Rheumatoid Arthritis in Puerto Rico

Long-Term Outcomes in Puerto Ricans with Rheumatoid Arthritis (RA) Receiving Early Treatment with Disease-Modifying Anti-Rheumatic Drugs using the American College of Rheumatology Definition of Early RA

Use of adjuvant chemotherapy in patients with stage III colon cancer in Puerto Rico: A population-based study

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