Bridging the Gap: Prednisone Use Patterns in Primary Care Reveal Challenges in Rheumatoid Arthritis Management and Access to Specialist Care
Bibliographic record
Abstract
Objectives To examine prednisone prescribing patterns and use among rheumatoid arthritis (RA) patients in Canadian primary care settings, exploring adherence to current guidelines and identifying factors influencing prescribing practices. Methods This mixed-methods study explored perspectives on RA care access through: Qualitative interviews with 33 people living with RA (PlwRA) across Canada Three focus groups with primary care providers (14 physicians, 1 manager, 1 pharmacist) in Alberta Quantitative analysis of prescribing patterns for 597 RA patients (2008-2020) using linked primary care electronic medical records (EMR) and pharmaceutical data from Southern AlbertaPlwRA interviews were guided by the Candidacy Framework[1] and a critical interpretive synthesis of RA literature.[2] Logistic regression analyzed associations between patient/physician characteristics and prednisone use. This approach combined in-depth individual perspectives with broader, generalizable data on RA care access and management. Results Among 597 RA patients identified from primary care EMR, annual point prevalence for prednisone (oral and injection) dispensing increased from 16% in 2008 to 29% in 2020. 65% of RA patients had at least 1 prednisone dispensation during the study period. Patients with higher comorbidity scores (calculated for the entire period of data capture) were more likely to receive prednisone (OR 1.20, 95% CI 1.02-1.41) (Table). 83% of 597 patients with incident DMARD prescriptions also had prednisone prescriptions, indicating its use as bridging therapy. Qualitative data also revealed PCPs’ reliance on prednisone for symptom management during long waits for rheumatologist consultations when no DMARDs were available to them, which ranged from less than a month to over 2 years. PlwRA reported diverse experiences with prednisone, from reluctance due to side effects to dependence for symptom control over extended periods of time. Conclusion Prednisone use in RA management often extends beyond the short-term use recommended in current guidelines, largely due to systemic challenges in accessing timely rheumatology care. While serving as crucial bridging therapy, prolonged prednisone use (continuous use exceeding 3 months) raises concerns about long-term risks. These findings highlight the need for improved care pathways and closer collaboration between rheumatologists and primary care providers to optimize RA management and reduce reliance on extended prednisone use. [1.] Dixon-Woods M. BMC Med Res Methodol 2006;6:35. [2.] Koehn S. BMC Health Serv Res 2024;24:986.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".