Is there disparate provision of biologic therapies for chronic inflammatory conditions in New Zealand?

Abstract

Biologic therapy is approved for the treatment of rheumatoid arthritis, inflammatory bowel disease and psoriasis in New Zealand. In order to qualify for subsidy for infliximab or adalimumab, treatment must be initiated by a relevant specialist. However, there is a clear role for family practitioners in ensuring that appropriate patients are offered these treatments regardless of ethnicity or levels of social deprivation. This issue was highlighted by the work of Mc Creanor and Nairn [1], who identified a tendency amongst non-Maori family physicians to attribute differences in health disparities as being due to the community itself. Such attitudes towards minority communities are widespread throughout the world and were most recently reported in the UK in the Report by the Commission on Race and Ethnic Disparities [2]. The potential for a significant role in the delivery of equitable care to Maoris and Pacific Islanders, following the passage of the Health Practitioners Competence Assurance Act, was outlined by Bacal et al [3]. General practitioners role in appropriate communication about new treatments was emphasised together with the fact that they were seen as trustworthy. Such relationships are often not established with specialist hospital-based practitioners, who may be seen as distant and disinterested. However, a study of arthritis in New Zealand has shown that despite the disease having a higher prevalence in indigenous peoples, fewer referrals were made by family doctors to specialists [4]. Consequently, their access to expensive treatments, such as biologic therapies was limited. In this small study, access to biologic therapy across various communities was considered.