Background/Purpose:

Aiming to broaden the care of lupus patients beyond the standard lupus management, we launched a pilot general health assessment (GHA) initiative under the umbrella of our lupus center. The goal of this initiative was to  systematically address potentially preventable lupus co- morbidities. The purpose of this analysis was to determine the one year impact of the GHA program on the care of our lupus patients.

Methods: The GHA program was implemented in September 2010 when our center’s nurse practitioner (NP) started to meet with each SLE patient during their Friday Lupus Clinic visit. During this visit, a list of pre-determined general health measures, developed by our center based on ACR and USPSTF recommendations (Table), are reviewed with the patients in order to determine the need for further intervention. Following this initial visit, the center NP: a) facilitates the implementation of yet “uncompleted” measures, by either ordering directly the proper test/intervention and/or by communicating the need to the treating physician; and  b) meets with the patients every 3-6 months (depending on the number of outstanding issues) to review the recommendations from the previous visit. For the purpose of this interim analysis, we compared the “completion” rates of GHA items between baseline and the 6-12 month visits (Chi-square test).

Results: 126 SLE patients completed a total of 315 visits between September 2010 and June 2012. Table demonstrates the proportion of GHA items that had been completed by patient’s rheumatologists and/or primary care physicians before each NP visit at baseline, 6 months, and 12 months. There was a significant increase in the “completion” rates of the GHA items that were addressable at the time of the nurse practitioner visit, e.g., vaccinations. However, GHA items that required an extra appointment for the patient, e.g., mammogram, had a lower rate of success. The major reasons for “uncompleted” tests were: personal misconception of such tests; difficulty with making appointments and feeling overburdened with too many medical appointments.

 

GHA Items	Baseline n:126	6m Visit n:92	12m Visit n 54
Influenza Vaccination	82(65%)	71(77%)	49(90%)*
Pneumonia Vaccination	33(26%)	32(35%)	32 (59%)*
PPD or Quantiferon	56 (44%)	64 (69%)*	51 (94%)*
HBsAg	71 (56%)	77 (83%)*	51(94%)*
HBsAb	70 (55%)	71 (77%)*	51(94%)*
Hep B Core	5 (4%)	28 (30%)*	32 (59%)*
Hepatitis C Antibody	75 (59%)	70 (76%)*	51 (94%)*
Vitamin D Level	113 (89%)	90 (98%)*	54 (100%)*
Eye Exam for HCQ º	113 (89%)	90 (97%)*	53 (98%)
PAP Smear º	87/107 (81%)	71/77 (92%)	39/44 (88%)
Mammogramº	45/59 (76%)	43/44(97%)*	22/23(96%)
Colonoscopyº	21/40 (52%)	21/30( 70%)	12/18 (67%)
DEXAº	61/114(52%)	54/86 (60%)	35/48 (67%)*
Calcium + Vit D	79 (65%)	64 (69%)	41 (76%)

 ºAddressed only if the test was indicated.

* p <0.05

Conclusion: Our lupus center general health assessment initiative demonstrates that additional visits with the center nurse practitioner at the time of patients’ regular physician visits can improve the patient care. We will continue our efforts to increase patient education regarding the importance of general health assessment to prevent lupus-related co-morbidities; we will also  work with physicians for improved coordination of care.

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« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-mary-kirkland-center-for-lupus-care-general-health-assessment-initiative-for-systemic-lupus-erythematosus-patients/