Document Detail

Impact of managed care health insurance system for indigent patients with rheumatoid arthritis in Puerto Rico.
MedLine Citation:
PMID:  23314687     Owner:  NLM     Status:  MEDLINE    
The aim of this study was to determine the clinical outcome among indigent patients with rheumatoid arthritis (RA) in Puerto Rico receiving their healthcare in a managed care system, as compared with non-indigent patients treated in fee-for-service settings. A cross-sectional study was conducted in 214 Puerto Ricans with RA (per American College of Rheumatology classification criteria). Demographic features, health-related behaviors, cumulative clinical manifestations, disease activity (per disease activity score 28), comorbid conditions, functional status (per Health Assessment Questionnaire), and pharmacologic profile were determined. Data were examined using uni- and multivariable (logistic regression) analyses. The mean (standard deviation (SD)) age of the study population was 56.6 (13.5) years; 180 (84.1 %) were women. The mean (SD) disease duration was 10.8 (9.6) years. Sixty-seven patients were treated in the managed care setting, and 147 patients received their healthcare in fee-for-service settings. In the multivariable analyses, RA patients treated in the managed care setting had more joint deformities, extra-articular manifestations, arterial hypertension, type 2 diabetes mellitus, cardiovascular events, fibromyalgia syndrome, and poorer functional status while having a lower exposure to biological agents than those treated in fee-for-service settings. Efforts should be undertaken to curtail the gap of health disparities among these Hispanic patients in order to improve their long-term outcomes.
Yesenia Santiago-Casas; Tania González-Rivera; Lesliane Castro-Santana; Grissel Ríos; David Martínez; Vanessa Rodríguez; Rafael González-Alcover; Angel M Mayor; Luis M Vilá
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-01-13
Journal Detail:
Title:  Clinical rheumatology     Volume:  32     ISSN:  1434-9949     ISO Abbreviation:  Clin. Rheumatol.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-06-14     Completed Date:  2014-02-05     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  8211469     Medline TA:  Clin Rheumatol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  763-9     Citation Subset:  IM    
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MeSH Terms
Arthritis, Rheumatoid / economics,  physiopathology,  therapy*
Cross-Sectional Studies
Insurance, Health / organization & administration*
Managed Care Programs / organization & administration*
Middle Aged
Multivariate Analysis
Puerto Rico / epidemiology
Regression Analysis
Treatment Outcome
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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