Patients with rheumatoid arthritis (RA) frequently develop comorbid conditions, which can be detected and managed through enhanced screenings and preventive medical care, such as immunizations. In Canada to date, quality measures for the screening and management of comorbidities in these patients have focused on care provided by rheumatologists. But what about primary care physicians, who are essential to disease prevention and to supporting rheumatologists?
New research by Jessica Widdifield, PhD, and colleagues from the Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, examined the management of comorbidity in RA patients within the primary care setting. Researchers developed and assessed quality measures related to screenings, process and outcome measures for patients both with and without RA. The results of this work were published in October 2017 Arthritis Care & Research.
Using data from the primary care Electronic Medical Record Administrative Data Linked Database (EMRALD) in Ontario, researchers harmonized the Canadian general population and RA clinical recommendations. From the database, 154,388 eligible patients from 209 primary care physicians were identified. For each RA patient, 10 non-RA patients were matched by age and sex, resulting in patients with a similar prevalence for comorbid conditions, such as hypertension, ischemic heart diseases and diabetes mellitus. In total, 1,405 RA patients were compared with 14,050 matched non-RA patients. Stratified analyses were performed, comparing patients with RA to those without RA, to assess the performance of these quality measures.
The Results
“Ontario primary care physicians tend to provide similar quality of care for patients with and without RA, but the performance of many process measures was suboptimal in both RA and non-RA patients,” write the authors in their discussion. “Many RA patients do not receive optimal preventive medical services, such as immunizations and screening for comorbid conditions.”
For general preventive care, RA patients were more likely to have been to their primary care physician within the past year, as well as to have undergone testing for bone mineral density, than non-RA patients. RA patients were also slightly more likely to receive vaccinations for influenza (44.9% vs. 40.0%) and pneumococcal pneumonia (40.4% vs. 34.1%) than non-RA patients. However, herpes zoster vaccinations were less frequent among RA patients than non-RA patients. RA patients also received less screenings for cervical cancer (58.6% vs. 64.0%) than non-RA patients. But no significant differences were observed between RA and non-RA patients in screenings for breast (70.7% vs. 73.8%) or colorectal (31.7% vs. 34.5%) cancers.