RAND Study Finds Arthritis Care for Older Patients Is Poor;
Lack of Information on Medication Safety Is Biggest Shortfall
The quality of medical care received by older people with arthritis is relatively poor and they receive recommended information about potential hazards of their medication less than half the time, according to a RAND Corporation study.
In the first study to measure the quality of arthritis care based on patient interviews, researchers from RAND Health, the David Geffen School of Medicine at UCLA and the Greater Los Angeles VA Healthcare System found that older patients received the recommended care for arthritis just 57 percent of the time.
Researchers found that failing to inform patients about medication safety was the most severe quality problem. Just 44 percent of the patients studied received the recommended information about the safety of their medication. In contrast, 64 percent had received some treatment for their arthritis.
Many studies of the quality of medical care rely on insurance claims or medical records. The new study is based on information provided directly by patients, some of which might not be found in medical records.
The RAND study focused on osteoarthritis – a debilitating disease that affects an estimated 50 to 80 percent of the nation's older population. It is the most common form of the disease, caused by the breakdown of the connective tissue in joints such as hands, knees and hips.
“The quality of arthritis care is similar to other medical conditions – which is not very good,” said Dr. David A. Ganz, a UCLA gerontologist and lead author of the study. “Arthritis dramatically affects the quality of life of older people. Better care would make a real difference in these patients' lives. However, as patients and doctors make choices about care options, attention to safety issues is essential.”
Researchers conducting the study interviewed 339 arthritis patients age 75 and older who received their medical care from two large medical groups in the western United States. The patients were asked in 2003 about their arthritis care in the previous year.
Ganz said the study's findings suggest that efforts to improve arthritis care should focus on assuring that instruction about safe medication use is given to patients, particularly since the older patients studied tend to be taking many prescription drugs.
The study is part of a project called Assessing the Care of Vulnerable Elders (ACOVE), an effort to examine the quality of health care provided to vulnerable older Americans who live independently. The project is a partnership between RAND Health and Pfizer Inc.
Researchers found that most of the arthritis care was provided to study participants by primary care physicians, with only 12 percent having seen a rheumatologist at least once during the period examined.
Other authors of the study are: Dr. John T. Chang, Fang Niu and Dr. David B. Reuben of UCLA; Carol P. Roth and Caren J. Kamberg of RAND; Dr. Neil S. Wenger of UCLA and RAND; Dr. Paul G. Shekelle and Dr. Catherine H. MacLean of RAND, UCLA and the Greater Los Angeles VA Healthcare System; and Min Guan of J.D. Power and Associates.
The study is titled “Quality of Osteoarthritis Care for Community-Dwelling Older Adults” and is published in the April edition of the journal Arthritis Care & Research.
RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care quality, costs and delivery, among other topics.
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