Impact of managed care health insurance system for indigent patients with rheumatoid arthritis in Puerto Rico
Autor: | Grissel Ríos, Lesliane E. Castro-Santana, Tania Gonzalez-Rivera, Vanessa E. Rodríguez, Luis M. Vilá, Yesenia Santiago-Casas, David Martínez, Rafael González-Alcover, Angel M. Mayor |
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Rok vydání: | 2012 |
Předmět: |
Adult
Male medicine.medical_specialty Cross-sectional study Article Arthritis Rheumatoid Rheumatology Internal medicine Surveys and Questionnaires Health care Medicine Humans Poverty Aged Insurance Health business.industry Managed Care Programs Puerto Rico General Medicine Middle Aged medicine.disease Health equity Cross-Sectional Studies Treatment Outcome Health assessment Rheumatoid arthritis Multivariate Analysis Physical therapy Managed care Population study Regression Analysis Female business |
Zdroj: | Clinical rheumatology. 32(6) |
ISSN: | 1434-9949 |
Popis: | 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 to 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, HAQ), and pharmacologic profile were determined. Data were examined using univariable 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 biologic 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. |
Databáze: | OpenAIRE |
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