The delivery of evidence-based preventive care for older Americans with arthritis

Abstract

IntroductionPrevious research suggests patients with rheumatoid arthritis (RA) may receive suboptimal care with respect to preventive tests and services. We evaluated the proportion of older Americans with RA, psoriatic arthritis (PsA), and osteoarthritis (OA) receiving these services and the specialty of the providers delivering this care.MethodsUsing data from 1999 to 2006 from the Medicare Chronic Conditions Warehouse, we identified persons age >/= 65 in the national 5% sample. Over the required five-year observation period, we identified tests and services recommended for older adults and the associated healthcare provider. Services of interest included dual energy x-ray absorptiometry (DXA), influenza and pneumococcal vaccination, hyperlipidemia lab testing, mammography and colonoscopy.ResultsAfter accounting for the sampling fraction, we identified 141,140 RA, 6,300 PsA, and 770,520 OA patients eligible for analysis. Over five years, a majority of RA, PsA, and OA patients were tested for hyperlipidemia (84%, 89% and 87% respectively) and received DXA (69%, 75%, and 52%). Only approximately one-third of arthritis patients received pneumococcal vaccination; 19% to 22% received influenza vaccination each year. Approximately 20% to 35% of arthritis patients never underwent mammography and colonoscopy over five years. Concomitant care from both a rheumatologist and a primary care physician was significantly associated with a greater likelihood of receiving almost all preventive tests and services.ConclusionsAmong older Americans on Medicare, the absolute proportion of persons with arthritis receiving various recommended preventive services and screening tests was substantially less than 100%. Improved co-management between primary care and arthritis physicians may in part improve the delivery of preventive care for arthritis patients, but novel systematic interventions in this area are needed.

Use of Lipid-lowering Agents in Rheumatoid Arthritis: A Population-based Cohort Study

“…This is in keeping with previous findings from our cohort and others reporting less than optimal preventive screening of individuals with RA (24, 25). It could be suggested that initial lower lipid levels in RA vs non-RA subjects may lead to the lower likelihood of subsequent reassessment of lipid levels in RA.…”

The effect of tofacitinib on pneumococcal and influenza vaccine responses in rheumatoid arthritis

“…40 Current literature suggests that rheumatologists do not routinely address the need for vaccination prior to starting therapy with biologic DMARDs, and for the most part, recommended vaccines are used infrequently among patients with RA. [41][42][43] While our study addressed two of the most important recommended vaccines, it should be noted that a newly available protein-conjugate vaccine for pneumococcus is recommended for patients with RA in the USA and other regions. 44 45 The pneumococcal conjugate vaccine (PCV-13) provides protection against 13 serotypes, 12 of which are contained within the PPSV-23 vaccine.…”

Comorbidities in rheumatoid arthritis

“…For example, the screening for the detection of breast cancer (a cancer which is not more frequent in rheumatoid arthritis than in the general population) by mammography might be less frequently performed in women with rheumatoid arthritis [50][51][52]. Most of the rheumatologists consider now that it is their responsibility, at least, to assess the screening for comorbidities and for risk factor of comorbidities and thereafter to liaise with the appropriate specialist for the treatment phase [33].…”