Prescribing Study Shows Similarities Between PAs, NPs And Physicians
An intriguing study that evaluated prescribing practices in primary care over a six-year period found a great deal of common ground between physician assistants (PAs), nurse practitioners (NPs) and physicians.

The study, which was presented as a poster at the annual meeting of the American Academy of Physician Assistants, found that physicians wrote prescriptions 62 percent of the time during patient office visits, NPs wrote prescriptions 70 percent of the time and PAs wrote prescriptions 60 percent of the time.

Roderick S. Hooker, PhD, PA, and Daisha J. Cipher, PhD, who coauthored the study, also found only negligible differences between PAs, NPs and physicians when they examined the likelihood of prescribing (from no prescriptions to five prescriptions per visit).

Drs. Hooker and Cipher were surprised by the strong prescribing similarities between PAs and physicians.

“This may mean (PAs) are practicing medicine in a consistent manner that does not differ markedly from that of the physician,” offers Dr. Hooker, the Director of Rheumatology Research with the Department of Veterans Affairs North Texas Health System in Dallas, and Dr. Cipher, an Assistant Professor at the School of Public Health at the University Of North Texas Sciences Center in Fort Worth, Tx..

For the study, Drs. Hooker and Cipher analyzed six years worth of data from the National Ambulatory Medical Care Survey, an annual sample survey of office-based physicians conducted by the National Center for Health Statistics.

According to the study, PAs and NPs appear to have an increased role as prescribers of medication nationally. Drs. Hooker and Cipher say enabling state legislation has facilitated this trend.

“The first legislation authorizing NPs and PAs to prescribe occurred in 1970 and over the span of 35 years, almost all states have expanded enabling legislation in this area,” say Drs. Hooker and Cipher.

There were some differences in terms of the type of patient visits. Nurse practitioners saw patients with acute problems nearly 45 percent of the time whereas PAs saw these patients 30.1 percent of the time and physicians saw these patients 32.4 percent of the time. While PAs and physicians saw patients with routine chronic problems 32.3 and 31.4 percent of the time respectively, NPs saw these patients 19 percent of the time.

Studies Show Impact Of Remicade For Psoriatic Arthritis
Emerging research shows Remicade (infliximab) offers sustained efficacy in reducing the signs and symptoms of psoriatic arthritis, and significantly inhibits joint destruction associated with the disease.

Over 60 percent of active psoriatic arthritis patients treated with Remicade were able to sustain at least a 20 percent improvement in symptoms at the two-year mark, according to findings from the Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT). Researchers presented these findings recently at the European League Against Rheumatism (EULAR) Annual European Congress of Rheumatology in Vienna, Austria.

Researchers noted other promising findings from the randomized, double-blind, multicenter study of 104 patients with active psoriatic arthritis. At the 98-week mark of treatment with Remicade, 64 percent of patients with a baseline Psoriasis Areas Severity Index (PASI) of 2.5 achieved a PASI 75 response. Patients in the Remicade group also had a sustained, improved response when it came to dactylitis and enthesopathy, which commonly affect up to one-third of patients with psoriatic arthritis.

Arthur Kavanaugh, MD, notes the study findings were promising on the efficacy of Remicade, which received its ninth FDA-approved indication in May for the treatment of active arthritis in patients with psoriatic arthritis.

“(The new data) show that Remicade is well maintained for up to two years in patients with psoriatic arthritis,” notes Dr. Kavanaugh, the Director of the Center for Innovative Therapy within the Division of Rheumatology, Allergy and Immunology at the University of California at San Diego.

At the EULAR conference, researchers also presented Phase 3 data from a separate study, IMPACT 2. Measuring structural damage with the vdH-S score, the researchers found that Remicade significantly limited the progression of structural damage associated with psoriatic arthritis. According to the presented data, at 24 weeks, patients with psoriatic arthritis who were treated with Remicade had a mean decrease of -.70 in the vdH-S score from the baseline whereas placebo-treated patients had an increase of .82.

Continuous NSAIDs For Ankylosing Spondylitis?
A new study shows that continuous NSAID treatment can have a greater impact than intermittent NSAID use in curtailing the progression of ankylosing spondylitis (AS), a chronic inflammatory disease that reportedly affects 500,000 people in the U.S.

The study, which was recently published in Arthritis And Rheumatism, evaluated two patient groups with AS. For the one group, researchers prescribed twice-a-day treatment with 100 mg of celecoxib, regardless of symptoms. For the other group, patients were instructed to take 100 mg celecoxib only when needed for significant pain or stiffness.

After two years, researchers note that X-rays showed a greater degree of AS progression and within a larger proportion of patients in the group who took celecoxib as needed to manage their pain. The study noted that twice as many patients in this group had moderate to high levels of spinal joint damage than those who took continuous celecoxib therapy.

Don Flinn, PA-C, says the study confirms his experience in using NSAIDs and COX-2 inhibitors.

“In our practice, NSAIDs and the available COX-2 inhibitors have been and will remain a mainstay of treatment for ankylosing spondylitis,” emphasizes Flinn, who is on the Board of Directors for The Oklahoma Academy of Physician Assistants and the Society of Physician Assistants in Rheumatology.

Flinn, who has been in practice for 24 years, says there are over 75 studies on celecoxib (Celebrex, Pfizer) and “the safety data are very convincing.” He says he feels comfortable prescribing celecoxib for long-term use and monitoring patients closely for blood pressure changes, swelling, and liver and renal enzyme changes.
“We are comfortable with this approach and have not had any problems picking up patients that may have side effects and stopping the drug,” points out Flinn.