@article{edwards_regional_2012,
	title = {Regional and temporal variation in the treatment of rheumatoid arthritis across the {UK}: a descriptive register-based cohort study},
	volume = {2},
	issn = {2044-6055},
	shorttitle = {Regional and temporal variation in the treatment of rheumatoid arthritis across the {UK}},
	doi = {10.1136/bmjopen-2012-001603},
	abstract = {OBJECTIVES: To describe current disease-modifying antirheumatic drugs (DMARDs) prescription in rheumatoid arthritis (RA) with reference to best practice and to identify temporal and regional trends in the UK.
DESIGN: Descriptive, register-based cohort study.
PARTICIPANTS: Permanently registered patients aged ≥18 years with a recorded diagnosis of RA between 1 January 1995 and 31 March 2010 and matched controls. Participants with RA were identified through screening of all patients in the General Practice Research Database (GPRD) with a clinical or referral record for RA and at least 1 day of follow-up.
SETTING: 639 general practices in the UK supplying data to the GPRD.
MAIN OUTCOME MEASURES: Medication prescribing between 3 and 12 months of RA diagnosis by region and time period (1995-1999, 2000-2005 and 2006-April 2010).
RESULTS: Of the 35 911 patients in the full RA cohort, 15 259 patients (42\%) had incident RA. Analysis of prescribing in incident RA patients demonstrated that between 1995 (baseline) and 2010 there was a substantial increase in DMARD, and specifically methotrexate, prescribing across all regions with a less marked increase in combination DMARD prescribing. Taking 12-month prescribing as a snapshot: DMARD prescribing was 19-49\% at baseline increasing to 45-74\% by 2006-April 2010; methotrexate prescribing was 4-16\% at baseline increasing to 32-60\%; combination DMARD prescribing was 0-8\% at baseline increasing to 3-17\%. However, there was marked regional variation in the proportion of RA patients receiving DMARD regardless of time period.
CONCLUSIONS: There has been a substantial increase in prescribing of DMARDs for RA since 1995; however, regional variation persists across the UK with relative undertreatment, according to established best practice. Improved implementation of evidence-based best clinical practice to facilitate removal of treatment variation is warranted. This may occur as a result of the implementation of published national guidance.},
	language = {eng},
	number = {6},
	journal = {BMJ open},
	author = {Edwards, Christopher John and Campbell, Jennifer and van Staa, Tjeerd and Arden, Nigel K.},
	year = {2012},
	pmid = {23144258},
	pmcid = {PMC3533005}
}