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Rheumatologic care of nursing home residents with rheumatoid arthritis: a comparison of the year before and after nursing home admission

  • Health Services Research
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Abstract

The purpose of this study was to investigate health care for patients with rheumatoid arthritis (RA) before and after admission to nursing homes. Data of a German health insurance fund from persons with diagnostic codes of RA, aged ≥65 years, admitted to a nursing home between 2010 and 2014 and continuously insured 1 year before and after admission were used. The proportion of patients with ≥1 rheumatologist visit and ≥1 prescription of biologic or conventional synthetic disease-modifying antirheumatic drugs (bDMARDs or csDMARDs), glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs) in the year before and after admission were calculated. Predictors of rheumatologic care after admission were analyzed by multivariable logistic regression. Of 75,697 nursing home residents, 2485 (3.3%) had RA (90.5% female, mean age 83.8). Treatment by rheumatologists and prescription of antirheumatic drugs decreased significantly in the year after admission (rheumatologic visits: 17.6 to 9.1%, bDMARDs: 2.1 to 1.5%, csDMARDs: 22.5 to 16.5%, glucocorticoids: 46.5 to 43.1%, NSAIDs: 47.4 to 38.5%). 60.2% of patients in rheumatologic care received csDMARDs compared with 14.5% without rheumatologic care. Rheumatologic care before admission to a nursing home strongly predicted rheumatologic care thereafter (OR 33.8, 95%-CI 23.2–49.2). Younger age and lower care level (reflecting need of help) were also associated with a higher chance of rheumatologic care. Rheumatologic care is already infrequent in old patients with RA and further decreases after admission to a nursing home. Patients without rheumatologic care are at high risk of insufficient treatment for their RA. Admission to a nursing home further increases this risk.

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Acknowledgements

We thank the DAK-Gesundheit for the opportunity to use the data for this analysis.

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Authors and Affiliations

  1. Department for Health Services Research, Carl von Ossietzky University, Ammerländer Heerstrasse 140, 26111, Oldenburg, Germany

    Andres Luque Ramos & Falk Hoffmann

  2. Epidemiology, German Rheumatism Research Centre, Berlin, Germany

    Katinka Albrecht & Angela Zink

  3. Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany

    Angela Zink

Authors
  1. Andres Luque Ramos
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  2. Katinka Albrecht
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  3. Angela Zink
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  4. Falk Hoffmann
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Correspondence to Andres Luque Ramos.

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Conflict of interest

The study was financed with own resources. All authors declare that they have no conflict of interest.

Human/animal studies

This article does not contain any studies with human participants or animals performed by any of the authors. This claims data analysis does not contain personal information.

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In this case an informed consent is not necessary in Germany.

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Luque Ramos, A., Albrecht, K., Zink, A. et al. Rheumatologic care of nursing home residents with rheumatoid arthritis: a comparison of the year before and after nursing home admission. Rheumatol Int 37, 2059–2064 (2017). https://doi.org/10.1007/s00296-017-3791-5

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  • DOI: https://doi.org/10.1007/s00296-017-3791-5

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