Skip to main content

Advertisement

SpringerLink
Log in

Patterns of preventive health services in rheumatoid arthritis patients compared to a primary care patient population

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

To determine the proportion of rheumatoid arthritis (RA) patients receiving preventive health care according to US Preventive Services Task Force recommendations compared with a community-based population sample, with emphasis on dyslipidemia testing, given the increased risk of cardiovascular disease (CVD) in RA patients. Patients with RA (ICD-9 code 714.0 at ≥2 office visits with a rheumatologist) and a primary care physician (PCP) at the Geisinger Health System (GHS) were identified through electronic health records. The records were searched back from 3/31/08 for the length of time required to satisfy each outcome measure. Percentages were compared with population testing rates using the Pearson Chi-square test. Eight hundred and thirty-one RA patients were compared to 169,476 subjects with a PCP at GHS, stratified by gender and age. Patients with RA were more likely to have had dyslipidemia and osteoporosis testing compared with the general population (86 vs. 75 and 75 vs. 55%, respectively, P < 0.0001 for both). The proportion of RA patients receiving breast and cervical cancer testing was similar to the general population. The majority (79%) of lipid testing was ordered by PCPs. Those RA patients with recommended lipid testing had more traditional CVD factors (hypertension, diabetes, coronary artery disease). RA patients are screened more than the general population for two RA-related co-morbidities, i.e. dyslipidemia and osteoporosis. The RA patients with traditional cardiovascular risk factors are more likely to be tested for dyslipidemia. Further work is warranted to improve testing for modifiable CVD risk factors in this group with multiple co-morbidities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK et al (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum 58(1):15–25

    Article  PubMed  Google Scholar 

  2. Wolfe F, Mitchell DM, Sibley JT, Fries JF, Bloch DA, Williams CA et al (1994) The mortality of rheumatoid arthritis. Arthritis Rheum 37(4):481–494

    Article  PubMed  CAS  Google Scholar 

  3. Watson DJ, Rhodes T, Guess HA (2003) All-cause mortality and vascular events among patients with rheumatoid arthritis, osteoarthritis, or no arthritis in the UK General Practice Research Database. J Rheumatol 30(6):1196–1202

    PubMed  Google Scholar 

  4. del Rincon ID, Williams K, Stern MP, Freeman GL, Escalante A (2001) High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 44(12):2737–2745

    Article  PubMed  Google Scholar 

  5. Solomon DH, Karlson EW, Rimm EB, Cannuscio CC, Mandl LA, Manson JE et al (2003) Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. See comment. Circulation 107(9):1303–1307

    Article  PubMed  Google Scholar 

  6. Maradit-Kremers H, Crowson CS, Nicola PJ, Ballman KV, Roger VL, Jacobsen SJ et al (2005) Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum 52(2):402–411

    Article  PubMed  Google Scholar 

  7. Wasko MC (2008) Rheumatoid arthritis and cardiovascular disease. Curr Rheumatol Rep 10(5):390–397

    Article  PubMed  Google Scholar 

  8. Kremers HM, Bidaut-Russell M, Scott CG, Reinalda MS, Zinsmeister AR, Gabriel SE (2003) Preventive medical services among patients with rheumatoid arthritis. J Rheumatol 30(9):1940–1947

    PubMed  Google Scholar 

  9. Solomon DH, Katz JN, Jacobs JP, La Tourette AM, Coblyn J (2002) Management of glucocorticoid-induced osteoporosis in patients with rheumatoid arthritis: rates and predictors of care in an academic rheumatology practice. Arthritis Rheum 46(12):3136–3142

    Article  PubMed  Google Scholar 

  10. Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK (2000) Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum 43(3):522–530

    Article  PubMed  CAS  Google Scholar 

  11. Dolan AL, Moniz C, Dasgupta B, Li F, Mackintosh C, Todd P et al (1997) Effects of inflammation and treatment on bone turnover and bone mass in polymyalgia rheumatica. Arthritis Rheum 40(11):2022–2029

    Article  PubMed  CAS  Google Scholar 

  12. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis. Arthritis Rheum 44(7):1496–1503

    Google Scholar 

  13. Ramsey-Goldman R, Dunn JE, Huang CF, Dunlop D, Rairie JE, Fitzgerald S et al (1999) Frequency of fractures in women with systemic lupus erythematosus: comparison with United States population data. Arthritis Rheum 42(5):882–890

    Article  PubMed  CAS  Google Scholar 

  14. Guide to Clinical Preventive Services (2008) Recommendations of the US Preventive Services Task Force. AHRQ Publication No. 08-05122, September 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/pocketgd08/

  15. Redelmeier DA, Tan SH, Booth GL (1988) The treatment of unrelated disorders in patients with chronic medical diseases. See comment. N Engl J Med 338(21):1516–1520

    Article  Google Scholar 

  16. Sharp PC, Michielutte R, Spangler JG, Cunningham L, Freimanis R (2005) Primary care providers’ concerns and recommendations regarding mammography screening for older women. J Cancer Educ 20(1):34–38

    Article  PubMed  Google Scholar 

  17. Nutting PA, Rost K, Smith J, Werner JJ, Elliot C (2000) Competing demands from physical problems: effect on initiating and completing depression care over 6 months. Arch Fam Med 9(10):1059–1064

    Article  PubMed  CAS  Google Scholar 

  18. Fontana SA, Baumann LC, Helberg C, Love RR (1997) The delivery of preventive services in primary care practices according to chronic disease status. Am J Public Health 87(7):1190–1196

    Article  PubMed  CAS  Google Scholar 

  19. Guzman-Clark JR, Fang MA, Sehl ME, Traylor L, Hahn TJ (2007) Barriers in the management of glucocorticoid-induced osteoporosis. Arthritis Rheum 57(1):140–146

    Article  PubMed  Google Scholar 

  20. Flocke SA, Stange KC, Goodwin MA (1998) Patient and visit characteristics associated with opportunistic preventive services delivery. J Fam Pract 47(3):202–208

    PubMed  CAS  Google Scholar 

  21. Ward MM (1999) Provision of primary care by office-based rheumatologists: results from the National Ambulatory Medical Care Surveys, 1991–1995. Arthritis Rheum 42(3):409–414

    Article  PubMed  CAS  Google Scholar 

  22. Lopez-Longo FJ, Oliver-Minarro D, de la Torre I, Gonzalez-Diaz de Rabago E, Sanchez-Ramon S, Rodriguez-Mahou M et al (2009) Association between anti-cyclic citrullinated peptide antibodies and ischemic heart disease in patients with rheumatoid arthritis. Arthritis Rheum 61(4):419–424

    Article  PubMed  CAS  Google Scholar 

  23. Cibere J, Sibley J, Haga M (1997) Rheumatoid arthritis and the risk of malignancy. Arthritis Rheum 40(9):1580–1586

    Article  PubMed  CAS  Google Scholar 

  24. Chakravarty EF, Genovese MC (2004) Associations between rheumatoid arthritis and malignancy. Rheum Dis Clin North Am 30(2):271–284

    Article  PubMed  Google Scholar 

  25. Park YB, Lee SK, Lee WK, Suh CH, Lee CW, Lee CH et al (1999) Lipid profiles in untreated patients with rheumatoid arthritis. J Rheumatol 26(8):1701–1704

    PubMed  CAS  Google Scholar 

  26. Park YB, Choi HK, Kim MY, Lee WK, Song J, Kim DK et al (2002) Effects of antirheumatic therapy on serum lipid levels in patients with rheumatoid arthritis: a prospective study. Am J Med 113(3):188–193

    Article  PubMed  CAS  Google Scholar 

  27. Al-Doghether M, Al-Tuwijri A, Khan A (2007) Obstacles to preventive intervention. Do physicians’ health habits and mind-set towards preventive care play any role? Saudi Med J 28(8):1269–1274

    PubMed  Google Scholar 

  28. Jaen CR, Stange KC, Nutting PA (1994) Competing demands of primary care: a model for the delivery of clinical preventive services. J Fam Pract 38(2):166–171

    PubMed  CAS  Google Scholar 

  29. Seeff LC, Nadel MR, Klabunde CN, Thompson T, Shapiro JA, Vernon SW et al (2004) Patterns and predictors of colorectal cancer test use in the adult U.S. population. Cancer 100(10):2093–2103

    Article  PubMed  Google Scholar 

  30. Kang-Kim M, Betancourt JR, Ayanian JZ, Zaslavsky AM, Yucel RM, Weissman JS (2008) Access to care, use of preventive services by Hispanics: state-based variations from 1991 to 2004. Med Care 46(5):507–515

    Article  PubMed  Google Scholar 

  31. Rosenberg L, Wise LA, Palmer JR, Horton NJ, Adams-Campbell LL (2005) A multilevel study of socioeconomic predictors of regular mammography use among African-American women. Cancer Epidemiol Biomarkers Prev 14(11 Pt 1):2628–2633

    Article  PubMed  Google Scholar 

  32. Centers for Disease Control and Prevention (CDC) (2005) Breast cancer screening and socioeconomic status–35 metropolitan areas, 2000 and 2002. MMWR Morb Mortal Wkly Rep 54(39):981–985

    Google Scholar 

  33. Ho V, Yamal JM, Atkinson EN, Basen-Engquist K, Tortolero-Luna G, Follen M (2005) Predictors of breast and cervical screening in Vietnamese women in Harris County, Houston, Texas. Cancer Nurs 28(2):119–129

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Institutional support. No grant or industrial support.

Author information

Authors and Affiliations

  1. Geisinger Health System, 100N. Academy Avenue, MC 13-41, Danville, PA, 17822, USA

    Androniki Bili, Lisa L. Schroeder, Lindsay J. Ledwich & Eric D. Newman

  2. Geisinger Center for Health Research, Geisinger, PA, USA

    H. Lester Kirchner

  3. Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Mary Chester M. Wasko

Authors
  1. Androniki Bili
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa L. Schroeder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lindsay J. Ledwich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Lester Kirchner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric D. Newman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mary Chester M. Wasko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Androniki Bili.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bili, A., Schroeder, L.L., Ledwich, L.J. et al. Patterns of preventive health services in rheumatoid arthritis patients compared to a primary care patient population. Rheumatol Int 31, 1159–1165 (2011). https://doi.org/10.1007/s00296-010-1461-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-010-1461-y

Keywords

Search

Navigation