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Prescribing for Children With Rheumatic Disease: Perceived Treatment Approaches Between Pediatric and Adult Rheumatologists
Author(s) -
Mater Heather,
Balevic Stephen J.,
Freed Gary L.,
Clark Sarah J.
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23273
Subject(s) - medicine , rheumatology , dosing , family medicine , limiting , feeling , rheumatic disease , physical therapy , disease , pediatrics , mechanical engineering , social psychology , psychology , engineering
Objective To compare practice patterns and prescribing differences for juvenile idiopathic arthritis ( JIA ) between adult rheumatologists ( AR s) and pediatric rheumatologists ( PR s), the perceived educational needs, and factors that enhance or impede co‐management. Methods Two parallel, cross‐sectional surveys focusing on JIA were administered in 2009 to a random sample of 193 PR s and 500 AR s using the American College of Rheumatology membership file. Bivariate analysis was conducted for common items. Results The response rate was 62.1% for AR s (n = 306) and 72.3% for PR s (n = 138). Only 23% of responding AR s (n = 69) reported caring for children with JIA . Of these, 94% strongly agreed/agreed feeling comfortable diagnosing JIA ; however, only 76% felt comfortable treating JIA . Clinical vignettes highlighted several prescribing differences. Forty‐eight percent of AR s and 31% of PR s felt medications to treat JIA did not have clear dosing guidelines. Though PR s initiated disease‐modifying antirheumatic drugs and biologic agents earlier, treatments were similar after 3 months. To enhance co‐management, 74% of pediatric respondents endorsed shared medical records. Conclusion Nearly one‐quarter of surveyed AR s care for children with JIA , with most limiting their practice to older children. There was more discomfort in treating JIA than diagnosing it, and there were significant prescribing differences. Both provider types identified the need for better dosing and treatment resources. Updated management guidelines along with exposure to pediatric rheumatology in fellowship could reduce treatment differences and enhance the care of children with JIA . Shared medical records and improvement in reimbursement may optimize co‐management.