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Impact of managed care health insurance system for indigent patients with rheumatoid arthritis in Puerto Rico

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Abstract

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.

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Acknowledgments

This project was supported by grant 8U54MD007587-03 (RCMI Clinical and Translational Research award, University of Puerto Rico Medical Sciences Campus) from the National Institute on Minority Health and Health Disparities (NIMHD) and by unrestricted educational grant from Abbott Laboratories, Inc.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, PO Box 365067, 00936-5067, San Juan, Puerto Rico

    Yesenia Santiago-Casas, Lesliane Castro-Santana, Grissel Ríos, David Martínez, Vanessa Rodríguez, Rafael González-Alcover, Ángel M. Mayor & Luis M. Vilá

  2. Division of Rheumatology, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA

    Tania González-Rivera

Authors
  1. Yesenia Santiago-Casas
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  2. Tania González-Rivera
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  3. Lesliane Castro-Santana
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  4. Grissel Ríos
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  5. David Martínez
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  6. Vanessa Rodríguez
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  7. Rafael González-Alcover
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  8. Ángel M. Mayor
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  9. Luis M. Vilá
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Correspondence to Luis M. Vilá.

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Santiago-Casas, Y., González-Rivera, T., Castro-Santana, L. et al. Impact of managed care health insurance system for indigent patients with rheumatoid arthritis in Puerto Rico. Clin Rheumatol 32, 763–769 (2013). https://doi.org/10.1007/s10067-013-2167-9

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  • DOI: https://doi.org/10.1007/s10067-013-2167-9

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