The Complexity of Care for Patients with Rheumatoid Arthritis

Kahn, Katherine L.; MacLean, Catherine H.; Liu, Honghu; Rubenstein, Laurence Z.; Wong, Andrew L.; Harker, Judith O.; Chen, Wen-Pin; Fitzpatrick, D.; Bulpitt, Ken J.; Traina, Shana; Mittman, Brian; Hahn, Bevra H.; Paulus, Harold E.

doi:10.1097/01.mlr.0000237425.58554.66

Cited by 26 publications

(4 citation statements)

References 27 publications

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“…CVD studies were predominantly from European countries, with several also from the US & Asia. For the MSD spectrum, six mean PCS estimates for LBP [ 4 , 10 , 31 , 40 – 42 ], seven for OA [ 3 , 10 , 31 , 33 , 41 , 43 ] and four for RA [ 25 , 44 – 46 ] were identified. MSD studies were predominantly from European countries, with several also from the US.…”

Section: Resultsmentioning

confidence: 99%

Variations in patient-reported physical health between cardiac and musculoskeletal diseases: systematic review and meta-analysis of population-based studies

Prior

Jordan

Kadam

2015

Health Qual Life Outcomes

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Population-based assessments of physical health are important to evaluate healthcare resource allocation. Normative data on the level of physical impairments attributable to specific diseases and severity levels within these diseases is critical to interpreting such data. Our objective, by means of a systematic review and meta-analysis, was to test the hypothesis that specific diseases which form cardiovascular and musculoskeletal disease spectra are associated with gradients of physical impairments. We examined a cardiovascular disease spectrum which consisted of hypertension, ischaemic heart disease and heart failure, and a musculoskeletal disease spectrum of lower back pain, osteoarthritis and rheumatoid arthritis. Using Medline, EMBASE and CINAHL databases, articles which had examined these morbidities and used either the SF-12 or SF-36 in general or primary care populations were selected; data was extracted independently by three reviewers. Study characteristics were described and the mean physical component summary scores of the SF-12 or SF-36 was analysed by disease, using random-effects meta-analysis. The association between disease and physical health (mean physical component summary scores) was assessed using multilevel meta-regression analysis, adjusting for age, health setting, country, disease definition and SF-12 or 36 format. From this search, 26 articles were identified, yielding 70 separate estimates of mean physical component summary scores across the morbidities from 14 different countries. For the selected conditions, pooled unadjusted mean physical component summary scores were: 44.4 for hypertension, 38.9 for ischaemic heart disease, 35.9 for heart failure, 39.5 for lower back pain, 36.0 for osteoarthritis and 36.5 for rheumatoid arthritis. The adjusted meta-regression showed mean physical component summary score difference for ischaemic heart disease of −4.6 (95 % confidence interval −6.0 to −3.2) and heart failure −7.5 (−9.1 to −5.9) compared to the hypertension category. For osteoarthritis −4.2 (−5.3 to −3.0) and rheumatoid arthritis −3.9 (−9.5 to 1.6) compared to the lower back pain category. Our findings provide the benchmark norms for the differences in physical health within and between disease spectra. Improved characterisation of the relative impact of individual conditions on physical health will facilitate public health assessments of chronic diseases as well as assessments of interventions using functional patient-reported outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-015-0265-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Variations in patient-reported physical health between cardiac and musculoskeletal diseases: systematic review and meta-analysis of population-based studies

Prior

Jordan

Kadam

2015

Health Qual Life Outcomes

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“…This cross‐sectional study queried physicians identified as fulfilling key roles by a population‐based sample of breast cancer patients in the Los Angeles Women's Health Study (LAW) (Chen et al 2008; Yoon et al 2008a, b) regarding the structure and organization of breast cancer care (Tisnado et al 2009). Physicians were considered as fulfilling key roles if they were named by a patient as specifically performing a cancer‐related function such as being the doctor in charge of decision making for delivery of chemotherapy, radiation therapy, or surgery (Kahn et al 2007). The sampling strategy is explained in greater detail in Appendix SA2.…”

Section: Datamentioning

confidence: 99%

Use of Interpreters by Physicians Treating Limited English Proficient Women with Breast Cancer: Results from the Provider Survey of the Los Angeles Women's Health Study

Rose

Tisnado

Malin

et al. 2010

Health Services Research

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Objective Little is known about how cancer physicians communicate with limited English proficient (LEP) patients. We studied physician-reported use and availability of interpreters. Data Sources A 2004 survey was fielded among physicians identified by a population-based sample of breast cancer patients. Three hundred and forty-eight physicians completed mailed surveys (response rate: 77 percent) regarding the structure and organization of care. Study Design and Settings We used logistic regression to analyze use and availability of interpreters. Principal Findings Most physicians reported treating LEP patients. Among physicians using interpreters within the last 12 months, 42 percent reported using trained medical interpreters, 21 percent telephone interpreter services, and 75 percent reported using untrained interpreters to communicate with LEP patients. Only one-third of physicians reported good availability of trained medical interpreters or telephone interpreter services when needed. Compared with HMO physicians, physicians in solo practice and single-specialty medical groups were less likely to report using trained medical interpreters or telephone interpreter services, and they were less likely to report good availability of these services. Conclusions There were important practice setting differences predicting use and availability of trained medical interpreters and telephone interpretation services. These findings may have troubling implications for effective physician–patient communication critically needed during cancer treatment.

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“…2 Patients with RA have an average of 6 visits per year with rheumatologists, in comparison with 5 visits in primary care (PC), underscoring the need for timely PC follow-up of elevated BP to diagnose and treat hypertension. 3 The American College of Rheumatology recognizes the need for BP control and has endorsed timely follow-up of elevated BPs as a quality measure for the Merit-based Incentive Payment System, defined as ≤4 weeks. 4 In prior work, our multidisciplinary team adapted a PC hypertension protocol and developed an implementation plan geared at rheumatology and specialty clinics.…”

mentioning

confidence: 99%

“…We previously reported that only 10% of eligible RA visits recommended follow-up of high blood pressure (BP) and that RA patients were less likely to have their hypertension diagnosed despite meeting identical longitudinal BP thresholds as peers 2 . Patients with RA have an average of 6 visits per year with rheumatologists, in comparison with 5 visits in primary care (PC), underscoring the need for timely PC follow-up of elevated BP to diagnose and treat hypertension 3 . The American College of Rheumatology recognizes the need for BP control and has endorsed timely follow-up of elevated BPs as a quality measure for the Merit-based Incentive Payment System, defined as ≤4 weeks 4…”

mentioning

confidence: 99%

Rheumatology High Blood Pressure Protocol Reduces Disparities, But Delays Remain for External Primary Care

Ferguson,

Hanlon,

Ramly

et al. 2024

J Clin Rheumatol

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Background/Objective To address high blood pressure (BP) in rheumatology patients, we previously implemented BP Connect, a brief staff-driven protocol to address high BP. Although timely follow-up and hypertension rates improved for patients with in-system primary care (PC), many receive PC and rheumatology care in separate health systems. In this cohort study, we compared rates of timely PC follow-up for high BP across-system health maintenance organizations (HMOs) before and after BP Connect implementation. Methods All adult patients with high rheumatology clinic BP and PC in that HMO were eligible. BP Connect's protocol engaged the staff in remeasuring high BP (≥140/90 mm Hg), advising cardiovascular disease risk, and connecting timely PC follow-up, which for patients with PC across system includes written follow-up instructions. After an eligible rheumatology visit, the next HMO PC visit with BP was used to determine rates and odds of timely follow-up before and after using multivariable logistic regression. Results Across 1327 rheumatology visits with high BP and across-system PC (2013–2019), 951 occurred after 2015 BP Connect implementation; 400 had confirmed high BP. Primary care follow-up rose from 20.5% to 23.5%. The odds of timely PC BP follow-up insignificantly changed (odds ratio, 1.19; confidence interval, 0.85–1.68). For visits with Black patients, the odds of timely follow-up did significantly increase (1.95; confidence interval, 1.02–3.79). Conclusions Timely follow-up for Black patients did improve, highlighting protocol interventions for more equitable health care. In contrast to our prior in-system study, BP Connect did not significantly improve follow-up with an across-system PC, indicating a need for direct scheduling. Future directions include piloting direct across-system scheduling.

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The Complexity of Care for Patients with Rheumatoid Arthritis

Cited by 26 publications

References 27 publications

Variations in patient-reported physical health between cardiac and musculoskeletal diseases: systematic review and meta-analysis of population-based studies

Variations in patient-reported physical health between cardiac and musculoskeletal diseases: systematic review and meta-analysis of population-based studies

Use of Interpreters by Physicians Treating Limited English Proficient Women with Breast Cancer: Results from the Provider Survey of the Los Angeles Women's Health Study

Rheumatology High Blood Pressure Protocol Reduces Disparities, But Delays Remain for External Primary Care

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