Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada.
Identifieur interne : 000119 ( Main/Corpus ); précédent : 000118; suivant : 000120Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada.
Auteurs : Jessica Widdifield ; Noah M. Ivers ; Sasha Bernatsky ; Liisa Jaakkimainen ; Claire Bombardier ; J Carter Thorne ; Vandana Ahluwalia ; J Michael Paterson ; Jacqueline Young ; Laura Wing ; Karen TuSource :
- Arthritis care & research [ 2151-4658 ] ; 2017.
English descriptors
- KwdEn :
- Adolescent (MeSH), Adult (MeSH), Aged (MeSH), Aged, 80 and over (MeSH), 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 (MeSH), Databases, Factual (MeSH), Diabetes Mellitus (diagnosis), Diabetes Mellitus (epidemiology), Diabetes Mellitus (therapy), Electronic Health Records (MeSH), Female (MeSH), Guideline Adherence (MeSH), Humans (MeSH), Male (MeSH), Mass Screening (methods), Middle Aged (MeSH), Neoplasms (diagnosis), Neoplasms (epidemiology), Neoplasms (therapy), Ontario (epidemiology), Physicians, Primary Care (MeSH), Practice Patterns, Physicians' (MeSH), Predictive Value of Tests (MeSH), Primary Health Care (MeSH), Process Assessment, Health Care (MeSH), Quality Indicators, Health Care (MeSH), Retrospective Studies (MeSH), Treatment Outcome (MeSH), Young Adult (MeSH).
- 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
Links to Exploration step
pubmed:27998044Le document en format XML
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<author><name sortKey="Ivers, Noah M" sort="Ivers, Noah M" uniqKey="Ivers N" first="Noah M" last="Ivers">Noah M. Ivers</name>
<affiliation><nlm:affiliation>Institute for Clinical Evaluative Sciences, University of Toronto, and Women's College Hospital, Toronto, Ontario, Canada.</nlm:affiliation>
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<author><name sortKey="Bernatsky, Sasha" sort="Bernatsky, Sasha" uniqKey="Bernatsky S" first="Sasha" last="Bernatsky">Sasha Bernatsky</name>
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<author><name sortKey="Jaakkimainen, Liisa" sort="Jaakkimainen, Liisa" uniqKey="Jaakkimainen L" first="Liisa" last="Jaakkimainen">Liisa Jaakkimainen</name>
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<author><name sortKey="Thorne, J Carter" sort="Thorne, J Carter" uniqKey="Thorne J" first="J Carter" last="Thorne">J Carter Thorne</name>
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<author><name sortKey="Ahluwalia, Vandana" sort="Ahluwalia, Vandana" uniqKey="Ahluwalia V" first="Vandana" last="Ahluwalia">Vandana Ahluwalia</name>
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<author><name sortKey="Paterson, J Michael" sort="Paterson, J Michael" uniqKey="Paterson J" first="J Michael" last="Paterson">J Michael Paterson</name>
<affiliation><nlm:affiliation>Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada, and McMaster University, Hamilton, Ontario, Canada.</nlm:affiliation>
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<author><name sortKey="Young, Jacqueline" sort="Young, Jacqueline" uniqKey="Young J" first="Jacqueline" last="Young">Jacqueline Young</name>
<affiliation><nlm:affiliation>Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.</nlm:affiliation>
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<author><name sortKey="Tu, Karen" sort="Tu, Karen" uniqKey="Tu K" first="Karen" last="Tu">Karen Tu</name>
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<idno type="eISSN">2151-4658</idno>
<imprint><date when="2017" type="published">2017</date>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent (MeSH)</term>
<term>Adult (MeSH)</term>
<term>Aged (MeSH)</term>
<term>Aged, 80 and over (MeSH)</term>
<term>Arthritis, Rheumatoid (diagnosis)</term>
<term>Arthritis, Rheumatoid (epidemiology)</term>
<term>Arthritis, Rheumatoid (therapy)</term>
<term>Cardiovascular Diseases (diagnosis)</term>
<term>Cardiovascular Diseases (epidemiology)</term>
<term>Cardiovascular Diseases (therapy)</term>
<term>Communicable Diseases (diagnosis)</term>
<term>Communicable Diseases (epidemiology)</term>
<term>Communicable Diseases (therapy)</term>
<term>Comorbidity (MeSH)</term>
<term>Databases, Factual (MeSH)</term>
<term>Diabetes Mellitus (diagnosis)</term>
<term>Diabetes Mellitus (epidemiology)</term>
<term>Diabetes Mellitus (therapy)</term>
<term>Electronic Health Records (MeSH)</term>
<term>Female (MeSH)</term>
<term>Guideline Adherence (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Male (MeSH)</term>
<term>Mass Screening (methods)</term>
<term>Middle Aged (MeSH)</term>
<term>Neoplasms (diagnosis)</term>
<term>Neoplasms (epidemiology)</term>
<term>Neoplasms (therapy)</term>
<term>Ontario (epidemiology)</term>
<term>Physicians, Primary Care (MeSH)</term>
<term>Practice Patterns, Physicians' (MeSH)</term>
<term>Predictive Value of Tests (MeSH)</term>
<term>Primary Health Care (MeSH)</term>
<term>Process Assessment, Health Care (MeSH)</term>
<term>Quality Indicators, Health Care (MeSH)</term>
<term>Retrospective Studies (MeSH)</term>
<term>Treatment Outcome (MeSH)</term>
<term>Young Adult (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Ontario</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Arthritis, Rheumatoid</term>
<term>Cardiovascular Diseases</term>
<term>Communicable Diseases</term>
<term>Diabetes Mellitus</term>
<term>Neoplasms</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Arthritis, Rheumatoid</term>
<term>Cardiovascular Diseases</term>
<term>Communicable Diseases</term>
<term>Diabetes Mellitus</term>
<term>Neoplasms</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Mass Screening</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Arthritis, Rheumatoid</term>
<term>Cardiovascular Diseases</term>
<term>Communicable Diseases</term>
<term>Diabetes Mellitus</term>
<term>Neoplasms</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adolescent</term>
<term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Comorbidity</term>
<term>Databases, Factual</term>
<term>Electronic Health Records</term>
<term>Female</term>
<term>Guideline Adherence</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Physicians, Primary Care</term>
<term>Practice Patterns, Physicians'</term>
<term>Predictive Value of Tests</term>
<term>Primary Health Care</term>
<term>Process Assessment, Health Care</term>
<term>Quality Indicators, Health Care</term>
<term>Retrospective Studies</term>
<term>Treatment Outcome</term>
<term>Young Adult</term>
</keywords>
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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>
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</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>
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<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>
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<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>
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<PubmedData><History><PubMedPubDate PubStatus="received"><Year>2016</Year>
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<Day>21</Day>
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<PubMedPubDate PubStatus="revised"><Year>2016</Year>
<Month>12</Month>
<Day>07</Day>
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<PubMedPubDate PubStatus="accepted"><Year>2016</Year>
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