Changes in Care After Implementing a Multifaceted Intervention to Improve Preventive Cardiology Practice in Rheumatoid Arthritis

Majka, Darcy S.; Lee, Ji Young; Peprah, Yaw; Lipiszko, Dawid; Friesema, Elisha M.; Ruderman, Eric; Persell, Stephen D.

doi:10.1177/1062860618798719

Cited by 8 publications

(7 citation statements)

References 21 publications

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“…This makes cardiovascular risk assessment (as well as assessment for these associated conditions) that much more important. Improving cardiovascular risk assessment techniques in patients with inflammatory arthritis is challenging and has been a topic of ongoing research [ 61 , 62 ].…”

Section: Management Of Obesity As a Cardiovascular Risk Factor In Psamentioning

confidence: 99%

Obesity and Psoriatic Arthritis: A Narrative Review

Kumthekar

Ogdie

2020

Rheumatol Ther

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Patients with psoriatic arthritis (PsA) have a higher burden of cardio-metabolic comorbidities like obesity, hypertension, diabetes, and cardiovascular disease compared to the general population. Adipose tissue is thought to promote a chronic low grade inflammatory state through inflammatory mediators like tumor necrosis factor alpha (TNFα), interleukin-6 (IL-6), leptin, and adiponectin. A higher body mass index (BMI) is a risk factor for development of PsA and affects disease activity and response to therapy including both disease-modifying anti-rheumatic drugs (DMARDs) and tumor necrosis factor inhibitors (TNFi). Obesity has an impact on the morbidity in PsA, particularly cardiovascular and/or metabolic. Patients with PsA have a higher cardiovascular risk and obesity may have an additive impact on morbidity and mortality. This review explores the relationship between obesity and PsA.

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Section: Management Of Obesity As a Cardiovascular Risk Factor In Psamentioning

confidence: 99%

Obesity and Psoriatic Arthritis: A Narrative Review

Kumthekar

Ogdie

2020

Rheumatol Ther

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“…Multifaceted interventions are those with two or more intervention components. Using a multifaceted intervention, a previous study reported that the intervention was effective in promoting disease-monitoring behavior among rheumatoid arthritis patients (Majka et al, 2018). Others validated the IMCHB-based intervention (Hickman, Clochesy, & Alaamri, 2016).…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Evaluation of the Interaction Model of Client Health Behavior‐based multifaceted intervention on patient activation and osteoarthritis symptoms

Ahn

Ham

2019

Japan Journal Nursing Sci

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Purpose This study evaluated a multifaceted intervention for osteoarthritis symptoms. Methods A cluster randomized controlled trial was conducted with a convenience sample of 90 patients aged between 45 and 82 years, who were recruited from three Community Health Posts (CHPs). The CHPs were randomized into two experimental groups (E1 and E2) and one control group (C). The intervention included health education and counseling combined with exercise classes based on the Interaction Model of Client Health Behavior. Trained community health nurse practitioners led the intervention. Stretching exercise (E1) and walking (E2) combined with muscle strengthening exercise were provided. The instruments included the Patient Activation Measure (PAM), Korean version of the Western Ontario and McMaster Universities Osteoarthritis Index (K‐WOMAC), Stanford Health Assessment Questionnaire Disability Scale (HAQDS), and Center for Epidemiologic Studies Depression Scale (CES‐D). The HAQDS was measured using an ordinal scale, and Likert scales were used for the other instruments. Chi‐square test and analysis of covariance were used; P values <.05 were considered significant. The study was conducted in 2014. Results The groups were similar at the baseline (P > .05) except for joint pain and patient activation (P < .05). At post‐test, the changes in the mean scores were significant for joint pain and stiffness, and physical functioning. E2 with walking exercise showed better improvements in joint pain and physical functioning than the other groups (P < .01). Conclusions Eight sessions of multifaceted intervention improved the osteoarthritis symptoms. Follow‐up studies will be needed to determine the intermediate and long‐term effects of the multifaceted intervention.

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“…These patients received care from 10 attending rheumatologists, 4 rheumatology fellows, 1 advanced practice nurse, and 2 physician assistants. Most of these clinicians had previously taken part in a prior cardiovascular disease prevention improvement study (16).…”

Section: Methodsmentioning

confidence: 99%

“…Strategies to improve CVD prevention in patients with RA have included the use of a specialty clinic for CVD prevention in patients with inflammatory joint disease (12) and efforts to improve collaborative care between rheumatologists and primary care (13)(14)(15)(16). Previously, we tested implementing a multifaceted quality improvement intervention consisting of clinician education, clinical decision support at the point of care, performance measurement and feed-back to rheumatology clinicians, and individualized mailed recommendations to patients to measure CVD risk factors and to address hypertension, cholesterol treatment, or smoking when applicable.…”

Section: Introductionmentioning

confidence: 99%

“…Previously, we tested implementing a multifaceted quality improvement intervention consisting of clinician education, clinical decision support at the point of care, performance measurement and feed-back to rheumatology clinicians, and individualized mailed recommendations to patients to measure CVD risk factors and to address hypertension, cholesterol treatment, or smoking when applicable. This combined intervention led to considerable increases in the proportion of patients with RA with all major CVD risk factors assessed but did not lead to significant improvements in CVD risk factor management or control (16). Furthermore, the rheumatologists surveyed were supportive of facilitating the referral process to PCPs for medical management of CVD risk factors.…”

Section: Introductionmentioning

confidence: 99%

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Outreach to Promote Management of Cardiovascular Risk in Primary Care Among Patients With Rheumatoid Arthritis Seen in Rheumatology Practice

Persell

Lee

Lipiszko

et al. 2020

ACR Open Rheumatology

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Objective Rheumatoid arthritis (RA) confers a 1.5‐ to 2.0‐fold increased risk of cardiovascular disease (CVD). A prior multifaceted quality improvement approach to improving CVD preventive care increased CVD risk factor assessments, but there was no significant effect on the management of risk factors. We tested the impact of adding a proactive outreach strategy promoting primary care treatment of CVD risk factors among patients with RA through their rheumatology practice. Methods Through electronic health record searches, we identified patients with RA who were potential candidates for hypertension treatment initiation or intensification, statin therapy, or a smoking‐cessation intervention. A nonclinician care manager contacted patients by phone and mail on behalf of the rheumatologists, provided information about the identified risk factor(s), recommend follow‐up with primary care physicians (PCPs), sent correspondence to PCPs, and followed up with patients to see what actions had been taken. We measured preventive cardiology quality indicators and compared preintervention and intervention time periods using interrupted time series methods. Results During the 6‐month intervention period, the proportion of patients prescribed at least moderate‐intensity statin treatment for primary prevention rose from 18.4% to 23.8%. The rate of increase was 1.06% greater per month than during the preceding period (P < 0.001). Rates of increase in hypertension diagnosis and control improved more rapidly during this phase (P < 0.001 for each) and reversed preceding negative trends. Conclusion Implementing proactive nonclinician outreach to encourage primary care–based treatment of CVD risk factors was associated with increases in statin prescribing and in hypertension diagnosis and control. Smoking was not affected.

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Changes in Care After Implementing a Multifaceted Intervention to Improve Preventive Cardiology Practice in Rheumatoid Arthritis

Cited by 8 publications

References 21 publications

Obesity and Psoriatic Arthritis: A Narrative Review

Obesity and Psoriatic Arthritis: A Narrative Review

Evaluation of the Interaction Model of Client Health Behavior‐based multifaceted intervention on patient activation and osteoarthritis symptoms

Outreach to Promote Management of Cardiovascular Risk in Primary Care Among Patients With Rheumatoid Arthritis Seen in Rheumatology Practice

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