Abstract
OBJECTIVE: To examine patterns of prednisone prescribing for rheumatoid arthritis (RA) management in primary care settings; and to explore experiences and perspectives of family physicians (FPs) and people living with RA regarding prednisone use. DESIGN: Mixed-methods study with sequential exploratory design. SETTING: Canada, particularly Alberta. PARTICIPANTS: Overall, 546 patients with RA in primary care electronic medical records in southern Alberta after excluding short-term prednisone prescriptions, 33 people living with RA from across Canada, and 16 primary care providers (14 family physicians, 1 clinic manager, 1 pharmacist). METHODS: Qualitative interviews and focus groups guided the analysis of primary care electronic medical records linked with provincial pharmaceutical dispensing data. Patterns of prednisone dispensing over 12 years, factors associated with prednisone use before and after RA documentation, and qualitative experiences with prednisone therapy were examined. MAIN FINDINGS: Each year between 2008 and 2019, at least 40% of patients with established RA received at least 1 prednisone prescription. Of patients receiving both prednisone and disease-modifying antirheumatic drugs (DMARDs) (41%, n=210), a subset (n=92) received prednisone before starting DMARDs, with 66% continuing prednisone for more than a year after DMARD initiation. Median time between first prednisone prescription and DMARD initiation was 124 days (interquartile range=13 to 1150 days). Three main qualitative themes were identified: prednisone is used as bridging therapy during the wait time to see a specialist, patients and providers have concerns about long-term use and side effects, and systemic barriers affecting access to guideline-concordant care exist and particularly impact male patients. CONCLUSION: Current prednisone prescribing patterns in RA management reveal divergence from guidelines recommending short-term use, suggesting systemic barriers to guideline-concordant care. Improving outcomes requires addressing both clinical needs driving prednisone use and systemic barriers perpetuating reliance on this medication.