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Rheumatology Advance Access originally published online on May 11, 2006
Rheumatology 2006 45(12):1555-1557; doi:10.1093/rheumatology/kel144
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Published by Oxford University Press on behalf of the British Society for Rheumatology 2006.

Are rheumatologists' treatment decisions influenced by patients' age?

L. Fraenkel1, N. Rabidou1 and R. Dhar2

1Department of Medicine, VA Connecticut Healthcare System, Yale University School of Medicine and 2Department of Marketing, Yale University School of Management, New Haven, CT, USA.

Correspondence to: Liana Fraenkel, Section of Rheumatology, Yale University School of Medicine, 300 Cedar ST, TAC Bldg, RM #525, PO Box 208031, New Haven, CT 06520-8031, USA. E-mail: liana.fraenkel{at}yale.edu

Objectives. The objective of this study was to determine whether physicians’ treatment preferences are influenced by patients’ age.

Methods. We mailed a survey to a random sample of rheumatologists practicing in the US. The survey included a scenario describing a hypothetical patient with rheumatoid arthritis (RA) on hydroxychloroquine, sulfasalazine and low-dose prednisolone, who presents with active disease during a follow-up appointment. The scenario was formulated in two versions that were identical except for the age of the patient. After reading the scenario, respondents were asked to rate (on a 10 cm numerical rating scale) their recommendations for each of the three options: (i) increasing the dose of prednisolone, (ii) adding a new disease-modifying anti-rheumatic drug (DMARD) and (iii) switching DMARDs. Rheumatologists who rated either adding a new DMARD or switching DMARDs higher than increasing the dose of prednisolone were classified as ‘preferring aggressive treatment with DMARDs’, while the others were classified as ‘NOT preferring aggressive treatment with DMARDs’.

Results. A total of 480 rheumatologists were mailed a questionnaire; 204 responded, giving a response rate of 42.5%. Overall 163 (80%) respondents were classified as preferring aggressive treatment with DMARDs. Rheumatologists responding to this survey were more likely to prefer aggressive DMARD treatment for the young RA patient vs the older RA patient (87 vs 71%, P= 0.007).

Conclusions. Our findings suggest that rheumatologists’ treatment recommendations may be influenced by age. Future educational efforts should increase physician awareness of this possible bias in order to ensure equal service delivery across ages.

KEY WORDS: Rheumatoid arthritis, Disease-modifying anti-rheumatic drugs, Decision-making


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