Ankylosing spondylitis diagnosis in US patients with back pain

identifying providers involved and factors associated with rheumatology referral delay

Atulya (Atul) Deodhar, Manish Mittal, Patrick Reilly, Yanjun Bao, Shivaji Manthena, Jaclyn Anderson, Avani Joshi

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

This study aimed to identify providers involved in diagnosing ankylosing spondylitis (AS) following back pain diagnosis in the USA and to identify factors leading to the delay in rheumatology referrals. The Truven Health MarketScan® US Commercial Database was searched for patients aged 18–64 years with back pain diagnosis in a non-rheumatology setting followed by AS diagnosis in any setting during January 2000–December 2012. Patients with a rheumatologist visit on or before AS diagnosis were considered referred. Cox regression was used to determine factors associated with referral time after adjusting for age, sex, comorbidities, physician specialty, drug therapy, and imaging procedures. Of 3336 patients included, 1244 (37 %) were referred to and diagnosed by rheumatologists; the others were diagnosed in primary care (25.7 %), chiropractic/physical therapy (7 %), orthopedic surgery (3.8 %), pain clinic (3.6 %), acute care (3.4 %), and other (19.2 %) settings. Median time from back pain diagnosis to rheumatology referral was 307 days and from first rheumatologist visit to AS diagnosis was 28 days. Referred patients were more likely to be younger (hazard ratio [HR] = 0.986; p <0.0001), male (HR = 1.15; p = 0.0163), diagnosed with uveitis (HR = 1.49; p = 0.0050), referred by primary care physicians (HR = 1.96; p <0.0001), prescribed non-steroidal anti-inflammatory drugs (HR = 1.55; p <0.0001), disease-modifying antirheumatic drugs (HR = 1.33; p <0.0001), and tumor necrosis factor inhibitors (HR = 1.40; p = 0.0036), and to have had spinal/pelvic X-ray prior to referral (HR = 1.28; p = 0.0003). During 2000–2012, most patients with AS were diagnosed outside of rheumatology practices. The delay before referral to rheumatology was 10 months; AS diagnosis generally followed within a month. Earlier referral of patients with AS signs and symptoms may lead to more timely diagnosis and appropriate treatment.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalClinical Rheumatology
DOIs
StateAccepted/In press - Mar 18 2016

Fingerprint

Ankylosing Spondylitis
Rheumatology
Back Pain
Referral and Consultation
Chiropractic
Pain Clinics
Antirheumatic Agents
Uveitis
Primary Care Physicians
Signs and Symptoms
Orthopedics
Comorbidity
Primary Health Care
Anti-Inflammatory Agents
Tumor Necrosis Factor-alpha
X-Rays
Databases
Physicians
Drug Therapy
Health

Keywords

  • Ankylosing spondylitis
  • Anti-TNF
  • Diagnostic delay
  • Referral strategies
  • Treatment patterns

ASJC Scopus subject areas

  • Rheumatology

Cite this

Ankylosing spondylitis diagnosis in US patients with back pain : identifying providers involved and factors associated with rheumatology referral delay. / Deodhar, Atulya (Atul); Mittal, Manish; Reilly, Patrick; Bao, Yanjun; Manthena, Shivaji; Anderson, Jaclyn; Joshi, Avani.

In: Clinical Rheumatology, 18.03.2016, p. 1-8.

Research output: Contribution to journalArticle

Deodhar, Atulya (Atul) ; Mittal, Manish ; Reilly, Patrick ; Bao, Yanjun ; Manthena, Shivaji ; Anderson, Jaclyn ; Joshi, Avani. / Ankylosing spondylitis diagnosis in US patients with back pain : identifying providers involved and factors associated with rheumatology referral delay. In: Clinical Rheumatology. 2016 ; pp. 1-8.
@article{c675e168843c4895b7b04d0736cb66b9,
title = "Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay",
abstract = "This study aimed to identify providers involved in diagnosing ankylosing spondylitis (AS) following back pain diagnosis in the USA and to identify factors leading to the delay in rheumatology referrals. The Truven Health MarketScan{\circledR} US Commercial Database was searched for patients aged 18–64 years with back pain diagnosis in a non-rheumatology setting followed by AS diagnosis in any setting during January 2000–December 2012. Patients with a rheumatologist visit on or before AS diagnosis were considered referred. Cox regression was used to determine factors associated with referral time after adjusting for age, sex, comorbidities, physician specialty, drug therapy, and imaging procedures. Of 3336 patients included, 1244 (37 {\%}) were referred to and diagnosed by rheumatologists; the others were diagnosed in primary care (25.7 {\%}), chiropractic/physical therapy (7 {\%}), orthopedic surgery (3.8 {\%}), pain clinic (3.6 {\%}), acute care (3.4 {\%}), and other (19.2 {\%}) settings. Median time from back pain diagnosis to rheumatology referral was 307 days and from first rheumatologist visit to AS diagnosis was 28 days. Referred patients were more likely to be younger (hazard ratio [HR] = 0.986; p <0.0001), male (HR = 1.15; p = 0.0163), diagnosed with uveitis (HR = 1.49; p = 0.0050), referred by primary care physicians (HR = 1.96; p <0.0001), prescribed non-steroidal anti-inflammatory drugs (HR = 1.55; p <0.0001), disease-modifying antirheumatic drugs (HR = 1.33; p <0.0001), and tumor necrosis factor inhibitors (HR = 1.40; p = 0.0036), and to have had spinal/pelvic X-ray prior to referral (HR = 1.28; p = 0.0003). During 2000–2012, most patients with AS were diagnosed outside of rheumatology practices. The delay before referral to rheumatology was 10 months; AS diagnosis generally followed within a month. Earlier referral of patients with AS signs and symptoms may lead to more timely diagnosis and appropriate treatment.",
keywords = "Ankylosing spondylitis, Anti-TNF, Diagnostic delay, Referral strategies, Treatment patterns",
author = "Deodhar, {Atulya (Atul)} and Manish Mittal and Patrick Reilly and Yanjun Bao and Shivaji Manthena and Jaclyn Anderson and Avani Joshi",
year = "2016",
month = "3",
day = "18",
doi = "10.1007/s10067-016-3231-z",
language = "English (US)",
pages = "1--8",
journal = "Clinical Rheumatology",
issn = "0770-3198",
publisher = "Springer London",

}

TY - JOUR

T1 - Ankylosing spondylitis diagnosis in US patients with back pain

T2 - identifying providers involved and factors associated with rheumatology referral delay

AU - Deodhar, Atulya (Atul)

AU - Mittal, Manish

AU - Reilly, Patrick

AU - Bao, Yanjun

AU - Manthena, Shivaji

AU - Anderson, Jaclyn

AU - Joshi, Avani

PY - 2016/3/18

Y1 - 2016/3/18

N2 - This study aimed to identify providers involved in diagnosing ankylosing spondylitis (AS) following back pain diagnosis in the USA and to identify factors leading to the delay in rheumatology referrals. The Truven Health MarketScan® US Commercial Database was searched for patients aged 18–64 years with back pain diagnosis in a non-rheumatology setting followed by AS diagnosis in any setting during January 2000–December 2012. Patients with a rheumatologist visit on or before AS diagnosis were considered referred. Cox regression was used to determine factors associated with referral time after adjusting for age, sex, comorbidities, physician specialty, drug therapy, and imaging procedures. Of 3336 patients included, 1244 (37 %) were referred to and diagnosed by rheumatologists; the others were diagnosed in primary care (25.7 %), chiropractic/physical therapy (7 %), orthopedic surgery (3.8 %), pain clinic (3.6 %), acute care (3.4 %), and other (19.2 %) settings. Median time from back pain diagnosis to rheumatology referral was 307 days and from first rheumatologist visit to AS diagnosis was 28 days. Referred patients were more likely to be younger (hazard ratio [HR] = 0.986; p <0.0001), male (HR = 1.15; p = 0.0163), diagnosed with uveitis (HR = 1.49; p = 0.0050), referred by primary care physicians (HR = 1.96; p <0.0001), prescribed non-steroidal anti-inflammatory drugs (HR = 1.55; p <0.0001), disease-modifying antirheumatic drugs (HR = 1.33; p <0.0001), and tumor necrosis factor inhibitors (HR = 1.40; p = 0.0036), and to have had spinal/pelvic X-ray prior to referral (HR = 1.28; p = 0.0003). During 2000–2012, most patients with AS were diagnosed outside of rheumatology practices. The delay before referral to rheumatology was 10 months; AS diagnosis generally followed within a month. Earlier referral of patients with AS signs and symptoms may lead to more timely diagnosis and appropriate treatment.

AB - This study aimed to identify providers involved in diagnosing ankylosing spondylitis (AS) following back pain diagnosis in the USA and to identify factors leading to the delay in rheumatology referrals. The Truven Health MarketScan® US Commercial Database was searched for patients aged 18–64 years with back pain diagnosis in a non-rheumatology setting followed by AS diagnosis in any setting during January 2000–December 2012. Patients with a rheumatologist visit on or before AS diagnosis were considered referred. Cox regression was used to determine factors associated with referral time after adjusting for age, sex, comorbidities, physician specialty, drug therapy, and imaging procedures. Of 3336 patients included, 1244 (37 %) were referred to and diagnosed by rheumatologists; the others were diagnosed in primary care (25.7 %), chiropractic/physical therapy (7 %), orthopedic surgery (3.8 %), pain clinic (3.6 %), acute care (3.4 %), and other (19.2 %) settings. Median time from back pain diagnosis to rheumatology referral was 307 days and from first rheumatologist visit to AS diagnosis was 28 days. Referred patients were more likely to be younger (hazard ratio [HR] = 0.986; p <0.0001), male (HR = 1.15; p = 0.0163), diagnosed with uveitis (HR = 1.49; p = 0.0050), referred by primary care physicians (HR = 1.96; p <0.0001), prescribed non-steroidal anti-inflammatory drugs (HR = 1.55; p <0.0001), disease-modifying antirheumatic drugs (HR = 1.33; p <0.0001), and tumor necrosis factor inhibitors (HR = 1.40; p = 0.0036), and to have had spinal/pelvic X-ray prior to referral (HR = 1.28; p = 0.0003). During 2000–2012, most patients with AS were diagnosed outside of rheumatology practices. The delay before referral to rheumatology was 10 months; AS diagnosis generally followed within a month. Earlier referral of patients with AS signs and symptoms may lead to more timely diagnosis and appropriate treatment.

KW - Ankylosing spondylitis

KW - Anti-TNF

KW - Diagnostic delay

KW - Referral strategies

KW - Treatment patterns

UR - http://www.scopus.com/inward/record.url?scp=84961203178&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961203178&partnerID=8YFLogxK

U2 - 10.1007/s10067-016-3231-z

DO - 10.1007/s10067-016-3231-z

M3 - Article

SP - 1

EP - 8

JO - Clinical Rheumatology

JF - Clinical Rheumatology

SN - 0770-3198

ER -