Organizational Background The Arthritis Foundation (AF) was founded in 1948 and is a non-profit organization that is dedicated to addressing the needs of individuals living with arthritis in the United States. There are an estimated 300,00 children, as well as 50 million adults, living with arthritis and this condition represents one of the nation's leading causes of disability in the U.S. The AF works to assist people with arthritis through multiple channels in order to mitigate some of the everyday struggles that people who live with this condition commonly endure. The foundation improves the lives of patients first by offering them the relevant information about their condition, which can sometimes be life changing for clients by itself. However, the AF also provides many other essential resources that are managed internally, such as providing resources, improving the access to care, facilitating research efforts, and building community relationship. For example, the AF, through its local offices nationwide, sponsors different events all year round to raise funds and increase awareness, such as hosting local walks and charity events.

The AF also grants two types of patient's registries which include the arthritis Internet registry (AIR) and the Childhood Arthritis and Rheum Alliance (CARRA), which are vital to creating the capacity to monitor and control symptoms, as well as provides an accurate population database that can improve research efforts by examining different patterns and collecting biological data from patients. The organization also provides services that include advocacy objectives to help this population have a voice on keys issues, both at the state and federal levels, to address issues such as relationships with regulators and insurers who can play an important role in treating the condition.

An additional resource that organization also provides, and serves as a primary organizational objective, is a dedication to scientific discovery which continues to provide leadership and helps to fund cutting-edge scientific efforts that attempts to discover more information about arthritis and potential treatments. FA provides help and support so that the organization can offer patients everything from trusted information to powerful tools that can help them connect with a network of concerned people. The foundation also works with many health care providers directly in order to strengthen its educational outreach and collective service offerings. There are many families in the U.S. who are currently living with juvenile arthritis and are in need of unique and urgent care for the estimated 300,00 children that have arthritis and the organization is dedicated to manage its resources in order to assist these families and their caregivers in the most effective and efficient manner possible.

Statement of Need/Objective Statement

One of the main leading causes of disability in the United States is Arthritis, which contributes to this condition being one of the costliest medical conditions in healthcare if the disease and its symptoms are not taken care of (Remmes Martin, Shreffler, Schoster & Callanhan, 2012). People with Arthritis have twice as high spending on prescription drugs and hospitalizations on average than those people with other chronic diseases which makes it important for individuals to get diagnosed and treated as soon as feasibly possible (Roebuck, Dougherty, Kaestner & Miller, 2015). However, there are many challenges in the healthcare system that can hinder the ability to effectively manage the symptoms related to the disease.

For example, the Medicaid program has issued a restriction on prescription drugs available to treat arthritis in order to decrease and control the rising prescription drug cost trend (Ramondetta et al., 2015). Decisions made about restricting certain drugs to patients are, at least in part, often based upon the health care plans assessment of the total costs associated with the treatment (Roebuck, Dougherty, Kaestner & Miller, 2015). However, a potential implication of the restriction of certain medications is the increased costs associated with hospitalization care when patients cannot control their pain levels (Ramondetta et al., 2015). Therefore, it has been argued that the restrictions on medications can lead to a higher volume of patients being admitted to the hospital, which in turn can result in the increase of net total medical costs of treatments; many patients often underuse medication due to the high costs of the drugs and they are required to pay these expenses out-of-pocket as a result of being either uninsured or underinsured (Remmes Martin, Shreffler, Schoster & Callanhan, 2012).

As a result, one public health trend that has been identified is that more patients are being emitted to the hospitals for arthritis related conditions which is correlated with the implementations of the restrictions placed on medications used to treat pain (Remmes Martin, Shreffler,...

These restrictions that have been made on prescription drug plans offered by the Medicaid healthcare plans for arthritis were enacted in an effort to decrease prescription drug costs on the whole (Ramondetta et al., 2015). However, while these restrictions have decreased the overall prescription drug costs, on the other hand these measures have also worked to increase the total medical care average cost for patients with arthritis (Remmes Martin, Shreffler, Schoster & Callanhan, 2012). The restrictions resulted in people discontinuing or minimizing their prescription drug use when compared with Medicaid patients use of the medications in a study a year earlier when there were no restrictions of these drugs in place (Wilson, Axelsen & Tang, 2005). This has led many to believe that the increased hospitalization rates are directly related to these restrictions which was focused on spending in Medicaid programs and this is not necessarily caused by an increase in arthritis cases (Lin, Bharel, Zhang, O'Connell & Clark, 2015).
According to Roebuck et al. (2015), an increase of one percent in prescription drug costs is estimated to be associated with a decrease in total Medicaid costs (Roebuck, Dougherty, Kaestner & Miller, 2015). Yet, even though spending on prescription drug cost has decreased, it is argued that the medical cost of patients that are hospitalized has increased significantly, resulting in higher total costs to the Medicaid system in the long run (Lin, Bharel, Zhang, O'Connell & Clark, 2015). However, the increased hospitalization rates could also be the result of frequent visits by homeless and low-income families that have limited resources available and have been impacted the most by the restrictions placed upon Medicaid health care plans (Lin, Bharel, Zhang, O'Connell & Clark, 2015). Therefore, one consideration that may have not been sufficiently controlled for, is the fact that studies are only focusing on the populations that have a low-income status (Lin, Bharel, Zhang, O'Connell & Clark, 2015).

Other studies have also focused on populations with individuals that were only enrolled in the Medicaid program and essentially excluded any other demographics in the research (Nielson & Barratt, 2009). Therefore, some have claimed that including only low-income people in the populations studied is not an accurate reflection of trends in the general population (Lin, Bharel, Zhang, O'Connell & Clark, 2015). A more comprehensive approach to conduct this type of research would be to not only look at patients enrolled in Medicaid programs, which are typically exclusively from low socioeconomic statuses, but to also include a more representative sample with patients that were covered by other healthcare plans as well.

Therefore, through expanded population and demographic sampling techniques, a more precise picture of the general population could be created and more accurately illustrate the trends that are present in the population from a broader general public heath perspective that includes a more representative sample of the U.S. population (Nielson & Barratt, 2009). Such research could help researchers gain insights as to the effects of the drug restrictions and determine more precisely if the general population is experiencing the same trends equally, or if these trends impact people from low socioeconomic statuses disproportionately, which could help decision makers to draft more informed public policies (Lin, Bharel, Zhang, O'Connell & Clark, 2015).

Project Description/Narrative

Hypothesis and specific aims:

This research effort has been designed to study the effects of the restrictions placed on prescription drugs for arthritis and whether these restrictions may lead to increases in hospitalization rates of arthritis patients. It is hypothesized that lower costs related to prescription drugs for arthritis will be correlated with a decrease in the hospitalization rate for patients suffering symptoms related to arthritis.

Methods

Sample selection/description of primary data sources:

The methodology that will be used in the study will include a cross sectional sample that will be used for a data analysis that will included from a particular community within a specific time that will be scheduled (Reichenheim & Coutino, 2010). The sample will be further restricted to individuals that are 18 years and older who are enrolled in either the Medicaid and Medicare programs and who may also be specifically interested in the potential healthcare association between osteoarthritis and rheumatoid arthritis. No prescription discount card or other prescription drug benefits will be offered and individuals will only be selected from households in which incomes are less than or equal to 100% of federal poverty level in this specific location. The study will be conducted in Irvine, TX, and will focus on the potential association…