Data from a quality improvement study she and her colleagues undertook to assess these barriers showed that multiple barriers contribute to patients not receiving adequate uveitis screening. The most common barrier, said Dr. Ballenger, was a systemic problem with the way in which her institution scheduled and obtained eye exams.
Among the problems identified was the lack of documentation in the electronic medical record (EMR) of the patient’s most recent eye exam, the wrong provider identified in the EMR or difficulty in scheduling an appointment.
Along with these systemic problems, other barriers to appropriate screening included lack of parental knowledge of the need for uveitis screening and access to care.
Barriers to appropriate screening included lack of parental knowledge of the need for uveitis screening & access to care.
Dr. Ballenger said the study highlights the need for rheumatologists “to understand the barriers of your population in order to make appropriate interventions.”
One way she and her colleagues have addressed this is to work with their colleagues in ophthalmology to improve their system problems. They also have been working on better communicating the importance of uveitis screening to their patients.
PROMIS Applied to Rheumatology
Two presentations showed the utility and effectiveness of using the Patient Reported Outcome Measurement Information System (PROMIS) in rheumatology. Developed by the National Institutes of Health, PROMIS is used for assessing multidimensional aspects of health for different conditions.
Alyssa Wohlfahrt, BA, project manager, Division of Rheumatology, Brigham and Women’s Hospital, Boston, presented findings of an ongoing, prospective, multi-site, observational study in which she and colleagues evaluated the performance of multiple PROMIS measures in the first 148 patients enrolled in the study.
All patients in the study had active rheumatoid arthritis (RA) that required starting or switching to a new DMARD. Patients in the study completed the PROMIS Global Health v1.1 short form and a number of PROMIS computer adapted tests (CATs).
The study found that many of the PROMIS measures were able to differentiate RA patients from the general population, and all the measures were able to distinguish RA patient groups by level of disease activity. When adjusting for age, sex, race, disease duration and seropositive status, a significant association was seen between patients with higher CDAI categories and higher PROMIS scores of pain, sleep, fatigue and anxiety, as well as lower PROMIS scores of physical and mental health. Both of these associations indicated worse symptoms.
The study also found PROMIS measures improved with starting a new DMARD, according to Ms. Wohlfahrt.
