GrippeCanadaV3, Main, Exploration, bibRecord, 000086

Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada.

Identifieur interne : 000086 ( Main/Exploration ); précédent : 000085; suivant : 000087

Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada.

Auteurs : Jessica Widdifield [Canada] ; Noah M. Ivers [Canada] ; Sasha Bernatsky [Canada] ; Liisa Jaakkimainen [Canada] ; Claire Bombardier [Canada] ; J Carter Thorne [Canada] ; Vandana Ahluwalia [Canada] ; J Michael Paterson [Canada] ; Jacqueline Young [Canada] ; Laura Wing [Canada] ; Karen Tu [Canada]

Source :

Arthritis care & research [ 2151-4658 ] ; 2017.

RBID : pubmed:27998044

Descripteurs français

English descriptors

KwdEn :
- Adolescent, Adult, Aged, Aged, 80 and over, Arthritis, Rheumatoid (diagnosis), Arthritis, Rheumatoid (epidemiology), Arthritis, Rheumatoid (therapy), Cardiovascular Diseases (diagnosis), Cardiovascular Diseases (epidemiology), Cardiovascular Diseases (therapy), Communicable Diseases (diagnosis), Communicable Diseases (epidemiology), Communicable Diseases (therapy), Comorbidity, Databases, Factual, Diabetes Mellitus (diagnosis), Diabetes Mellitus (epidemiology), Diabetes Mellitus (therapy), Electronic Health Records, Female, Guideline Adherence, Humans, Male, Mass Screening (methods), Middle Aged, Neoplasms (diagnosis), Neoplasms (epidemiology), Neoplasms (therapy), Ontario (epidemiology), Physicians, Primary Care, Practice Patterns, Physicians', Predictive Value of Tests, Primary Health Care, Process Assessment, Health Care, Quality Indicators, Health Care, Retrospective Studies, Treatment Outcome, Young Adult.
MESH :
- geographic , epidemiology : Ontario.
- diagnosis : Arthritis, Rheumatoid, Cardiovascular Diseases, Communicable Diseases, Diabetes Mellitus, Neoplasms.
- epidemiology : Arthritis, Rheumatoid, Cardiovascular Diseases, Communicable Diseases, Diabetes Mellitus, Neoplasms.
- methods : Mass Screening.
- therapy : Arthritis, Rheumatoid, Cardiovascular Diseases, Communicable Diseases, Diabetes Mellitus, Neoplasms.
- Adolescent, Adult, Aged, Aged, 80 and over, Comorbidity, Databases, Factual, Electronic Health Records, Female, Guideline Adherence, Humans, Male, Middle Aged, Physicians, Primary Care, Practice Patterns, Physicians', Predictive Value of Tests, Primary Health Care, Process Assessment, Health Care, Quality Indicators, Health Care, Retrospective Studies, Treatment Outcome, Young Adult.

Abstract

OBJECTIVE

Quality measurement for rheumatoid arthritis (RA) patients has largely focused on care provided by rheumatologists. Our aim was to develop and assess quality measures related to the screening and management of comorbidity in RA patients in primary care.

METHODS

We used the primary care Electronic Medical Record Administrative data Linked Database in Ontario, Canada. We harmonized Canadian general population and RA clinical recommendations to develop and assess screening, process, and outcome measures. For each RA patient, 10 non-RA patients were matched by age and sex. Stratified analyses were performed, comparing patients with RA to those without RA, to assess the performance of quality measures.

RESULTS

We compared 1,405 RA patients to 14,050 matched non-RA patients (72.8% female; mean age 62.5 years). Compared to non-RA patients, RA patients more frequently had influenza (44.9% versus 40.0%) and pneumococcal (40.4% versus 34.1%) vaccinations and bone mineral density testing (67.4% versus 58.1%). Herpes zoster vaccinations were less frequent among RA patients (13.8% versus 19.5%), as was screening for cervical cancer (58.6% versus 64.0%). No significant differences were observed between RA and non-RA patients in screenings for breast (70.7% versus 73.8%) or colorectal (31.7% versus 34.5%) cancers. Only a quarter of RA patients had a comprehensive cardiovascular risk assessment. No definitive differences were detected in the management of patients who had co-occurring cardiovascular disease or diabetes mellitus.

CONCLUSION

For both RA and non-RA patients, compliance with Canadian recommendations for preventive medical services and screening for comorbid conditions in primary care was less than optimal. This indicates key targets for improvement.

DOI: 10.1002/acr.23178
PubMed: 27998044

Affiliations:

Links toward previous steps (curation, corpus...)

to stream Main, to step Corpus: 000111
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Le document en format XML

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<term>Cardiovascular Diseases</term>
<term>Communicable Diseases</term>
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<term>Databases, Factual</term>
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<term>Guideline Adherence</term>
<term>Humans</term>
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<term>Middle Aged</term>
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<term>Practice Patterns, Physicians'</term>
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<front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b>
</p>
<p>Quality measurement for rheumatoid arthritis (RA) patients has largely focused on care provided by rheumatologists. Our aim was to develop and assess quality measures related to the screening and management of comorbidity in RA patients in primary care.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>We used the primary care Electronic Medical Record Administrative data Linked Database in Ontario, Canada. We harmonized Canadian general population and RA clinical recommendations to develop and assess screening, process, and outcome measures. For each RA patient, 10 non-RA patients were matched by age and sex. Stratified analyses were performed, comparing patients with RA to those without RA, to assess the performance of quality measures.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>We compared 1,405 RA patients to 14,050 matched non-RA patients (72.8% female; mean age 62.5 years). Compared to non-RA patients, RA patients more frequently had influenza (44.9% versus 40.0%) and pneumococcal (40.4% versus 34.1%) vaccinations and bone mineral density testing (67.4% versus 58.1%). Herpes zoster vaccinations were less frequent among RA patients (13.8% versus 19.5%), as was screening for cervical cancer (58.6% versus 64.0%). No significant differences were observed between RA and non-RA patients in screenings for breast (70.7% versus 73.8%) or colorectal (31.7% versus 34.5%) cancers. Only a quarter of RA patients had a comprehensive cardiovascular risk assessment. No definitive differences were detected in the management of patients who had co-occurring cardiovascular disease or diabetes mellitus.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSION</b>
</p>
<p>For both RA and non-RA patients, compliance with Canadian recommendations for preventive medical services and screening for comorbid conditions in primary care was less than optimal. This indicates key targets for improvement.</p>
</div>
</front>
</TEI>
<pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">27998044</PMID>
<DateCompleted><Year>2017</Year>
<Month>10</Month>
<Day>10</Day>
</DateCompleted>
<DateRevised><Year>2019</Year>
<Month>12</Month>
<Day>10</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">2151-4658</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>69</Volume>
<Issue>10</Issue>
<PubDate><Year>2017</Year>
<Month>10</Month>
</PubDate>
</JournalIssue>
<Title>Arthritis care & research</Title>
<ISOAbbreviation>Arthritis Care Res (Hoboken)</ISOAbbreviation>
</Journal>
<ArticleTitle>Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada.</ArticleTitle>
<Pagination><MedlinePgn>1495-1503</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1002/acr.23178</ELocationID>
<Abstract><AbstractText Label="OBJECTIVE">Quality measurement for rheumatoid arthritis (RA) patients has largely focused on care provided by rheumatologists. Our aim was to develop and assess quality measures related to the screening and management of comorbidity in RA patients in primary care.</AbstractText>
<AbstractText Label="METHODS">We used the primary care Electronic Medical Record Administrative data Linked Database in Ontario, Canada. We harmonized Canadian general population and RA clinical recommendations to develop and assess screening, process, and outcome measures. For each RA patient, 10 non-RA patients were matched by age and sex. Stratified analyses were performed, comparing patients with RA to those without RA, to assess the performance of quality measures.</AbstractText>
<AbstractText Label="RESULTS">We compared 1,405 RA patients to 14,050 matched non-RA patients (72.8% female; mean age 62.5 years). Compared to non-RA patients, RA patients more frequently had influenza (44.9% versus 40.0%) and pneumococcal (40.4% versus 34.1%) vaccinations and bone mineral density testing (67.4% versus 58.1%). Herpes zoster vaccinations were less frequent among RA patients (13.8% versus 19.5%), as was screening for cervical cancer (58.6% versus 64.0%). No significant differences were observed between RA and non-RA patients in screenings for breast (70.7% versus 73.8%) or colorectal (31.7% versus 34.5%) cancers. Only a quarter of RA patients had a comprehensive cardiovascular risk assessment. No definitive differences were detected in the management of patients who had co-occurring cardiovascular disease or diabetes mellitus.</AbstractText>
<AbstractText Label="CONCLUSION">For both RA and non-RA patients, compliance with Canadian recommendations for preventive medical services and screening for comorbid conditions in primary care was less than optimal. This indicates key targets for improvement.</AbstractText>
<CopyrightInformation>© 2016, American College of Rheumatology.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Widdifield</LastName>
<ForeName>Jessica</ForeName>
<Initials>J</Initials>
<Identifier Source="ORCID">0000-0002-7464-0460</Identifier>
<AffiliationInfo><Affiliation>Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, and Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Ivers</LastName>
<ForeName>Noah M</ForeName>
<Initials>NM</Initials>
<AffiliationInfo><Affiliation>Institute for Clinical Evaluative Sciences, University of Toronto, and Women's College Hospital, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Bernatsky</LastName>
<ForeName>Sasha</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Jaakkimainen</LastName>
<ForeName>Liisa</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Bombardier</LastName>
<ForeName>Claire</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>University of Toronto and University Health Network, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Thorne</LastName>
<ForeName>J Carter</ForeName>
<Initials>JC</Initials>
<AffiliationInfo><Affiliation>University of Toronto, Toronto, Ontario, Canada, and Southlake Regional Health Centre, Newmarket, Ontario, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Ahluwalia</LastName>
<ForeName>Vandana</ForeName>
<Initials>V</Initials>
<AffiliationInfo><Affiliation>William Osler Health Centre, Brampton, Ontario, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Paterson</LastName>
<ForeName>J Michael</ForeName>
<Initials>JM</Initials>
<AffiliationInfo><Affiliation>Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada, and McMaster University, Hamilton, Ontario, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Young</LastName>
<ForeName>Jacqueline</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wing</LastName>
<ForeName>Laura</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Tu</LastName>
<ForeName>Karen</ForeName>
<Initials>K</Initials>
<AffiliationInfo><Affiliation>Institute for Clinical Evaluative Sciences, University of Toronto, Sunnybrook Health Sciences Centre, and University Health Network, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<GrantList CompleteYN="Y"><Grant><GrantID>119348</GrantID>
<Agency>CIHR</Agency>
<Country>Canada</Country>
</Grant>
</GrantList>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic"><Year>2017</Year>
<Month>08</Month>
<Day>22</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo><Country>United States</Country>
<MedlineTA>Arthritis Care Res (Hoboken)</MedlineTA>
<NlmUniqueID>101518086</NlmUniqueID>
<ISSNLinking>2151-464X</ISSNLinking>
</MedlineJournalInfo>
<CitationSubset>IM</CitationSubset>
<MeshHeadingList><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D001172" MajorTopicYN="N">Arthritis, Rheumatoid</DescriptorName>
<QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
<QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D002318" MajorTopicYN="N">Cardiovascular Diseases</DescriptorName>
<QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
<QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D003141" MajorTopicYN="N">Communicable Diseases</DescriptorName>
<QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
<QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D015897" MajorTopicYN="N">Comorbidity</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D016208" MajorTopicYN="N">Databases, Factual</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D003920" MajorTopicYN="N">Diabetes Mellitus</DescriptorName>
<QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
<QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D057286" MajorTopicYN="N">Electronic Health Records</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D019983" MajorTopicYN="N">Guideline Adherence</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008403" MajorTopicYN="N">Mass Screening</DescriptorName>
<QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D009369" MajorTopicYN="N">Neoplasms</DescriptorName>
<QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
<QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D009864" MajorTopicYN="N" Type="Geographic">Ontario</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D058007" MajorTopicYN="N">Physicians, Primary Care</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D010818" MajorTopicYN="N">Practice Patterns, Physicians'</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011237" MajorTopicYN="N">Predictive Value of Tests</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011320" MajorTopicYN="Y">Primary Health Care</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D017064" MajorTopicYN="N">Process Assessment, Health Care</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D019984" MajorTopicYN="Y">Quality Indicators, Health Care</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName>
</MeshHeading>
</MeshHeadingList>
</MedlineCitation>
<PubmedData><History><PubMedPubDate PubStatus="received"><Year>2016</Year>
<Month>08</Month>
<Day>21</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="revised"><Year>2016</Year>
<Month>12</Month>
<Day>07</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="accepted"><Year>2016</Year>
<Month>12</Month>
<Day>13</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="pubmed"><Year>2016</Year>
<Month>12</Month>
<Day>21</Day>
<Hour>6</Hour>
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<PubMedPubDate PubStatus="medline"><Year>2017</Year>
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<PubMedPubDate PubStatus="entrez"><Year>2016</Year>
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<PublicationStatus>ppublish</PublicationStatus>
<ArticleIdList><ArticleId IdType="pubmed">27998044</ArticleId>
<ArticleId IdType="doi">10.1002/acr.23178</ArticleId>
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<affiliations><list><country><li>Canada</li>
</country>
<region><li>Ontario</li>
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<settlement><li>Toronto</li>
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<orgName><li>Université de Toronto</li>
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</list>
<tree><country name="Canada"><noRegion><name sortKey="Widdifield, Jessica" sort="Widdifield, Jessica" uniqKey="Widdifield J" first="Jessica" last="Widdifield">Jessica Widdifield</name>
</noRegion>
<name sortKey="Ahluwalia, Vandana" sort="Ahluwalia, Vandana" uniqKey="Ahluwalia V" first="Vandana" last="Ahluwalia">Vandana Ahluwalia</name>
<name sortKey="Bernatsky, Sasha" sort="Bernatsky, Sasha" uniqKey="Bernatsky S" first="Sasha" last="Bernatsky">Sasha Bernatsky</name>
<name sortKey="Bombardier, Claire" sort="Bombardier, Claire" uniqKey="Bombardier C" first="Claire" last="Bombardier">Claire Bombardier</name>
<name sortKey="Ivers, Noah M" sort="Ivers, Noah M" uniqKey="Ivers N" first="Noah M" last="Ivers">Noah M. Ivers</name>
<name sortKey="Jaakkimainen, Liisa" sort="Jaakkimainen, Liisa" uniqKey="Jaakkimainen L" first="Liisa" last="Jaakkimainen">Liisa Jaakkimainen</name>
<name sortKey="Paterson, J Michael" sort="Paterson, J Michael" uniqKey="Paterson J" first="J Michael" last="Paterson">J Michael Paterson</name>
<name sortKey="Thorne, J Carter" sort="Thorne, J Carter" uniqKey="Thorne J" first="J Carter" last="Thorne">J Carter Thorne</name>
<name sortKey="Tu, Karen" sort="Tu, Karen" uniqKey="Tu K" first="Karen" last="Tu">Karen Tu</name>
<name sortKey="Wing, Laura" sort="Wing, Laura" uniqKey="Wing L" first="Laura" last="Wing">Laura Wing</name>
<name sortKey="Young, Jacqueline" sort="Young, Jacqueline" uniqKey="Young J" first="Jacqueline" last="Young">Jacqueline Young</name>
</country>
</tree>
</affiliations>
</record>

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Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada.

Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada.

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