Individual variations in treatment decisions by Swedish rheumatologists regarding biological drugs for XXXX .

@entity1 @entity309
OBJECTIVES: In Sweden, reports indicate surprisingly large regional variation in prescription of biological drugs despite a growing number of clinical studies describing their beneficial effects and guidelines by professional organizations and agencies. Our objectives were to ascertain whether there is also variation between individual rheumatologists in prescribing biologics to @entity1 with @entity309 ( @entity309 ) and to evaluate reasons for treatment choices. METHOD: Ten hypothetical @entity1 cases were constructed and presented to 26 rheumatologists in five regions in Sweden. The cases were based on actual cases and were thoroughly elaborated by a senior rheumatologist and pre-tested in a pilot study. The respondents were asked whether they would treat the @entity1 with a biological agent (Yes/No) and to explain their decisions. RESULTS: The response rate was 26/105 (25%). Treatment choices varied considerably between the rheumatologists, some prescribing biologics to 9/10 @entity1 and others to 2/10. In five of the 10 hypothetical cases, approximately half of the respondents would prescribe biologics. No regions with particularly high or low prescription were identified. Both the decisions to prescribe biologics and also not to prescribe biologics were mainly motivated by medical reasons. Some rheumatologists also referred to lifestyle-related factors or the social function of the @entity1 . CONCLUSIONS: The choice of initiation of biologics varied substantially among rheumatologists presented with hypothetical @entity1 cases, and there were also disparities between rheumatologists practicing at the same clinic. Treatment choices were motivated primarily by medical reasons. This situation raises concerns about a lack of consensus in @entity309 treatment strategies.
