Session Information
Session Type: ACR/ARHP Combined Abstract Session
Session Time: 9:00AM-11:00AM
Background/Purpose: Patients with rheumatologic conditions are at a higher risk of cardiovascular disease (CVD) than peers. High blood pressure (BP) and tobacco use exacerbate CVD risk, yet many times these risk factors are unaddressed in patients in rheumatology clinics. We interviewed rheumatology clinic staff to identify facilitators and barriers to addressing high BP and tobacco to inform the development and dissemination of tailored CVD risk management protocols in specialty clinics.
Methods: Medical assistants, nurses, and scheduling staff from four adult rheumatology clinics in two health systems were interviewed by two expert facilitators in seven 60 minute focus groups (n=23 BP and n=14 tobacco group participants). We analyzed transcripts using qualitative content analysis with NVivo 11 software.
Results: We found systems- (Table 1) and person-level (Table 2) facilitators and barriers to addressing BP and tobacco. Across both health systems, rheumatology clinic staff’s usual practices followed three process steps: (1) identify high BP or tobacco use, (2) follow-up within the clinic, and (3) follow-up across settings (i.e. with primary care and community resources). Focus groups identified the two key barriers as (1) lack of a system for follow-up, both within the specialty clinic and across settings, and (2) staff needs for talking points during patient interactions to address high BP and tobacco. Fragmented staff to provider communication and role perceptions were also reported as contributing to these barriers.
Conclusion: Our study identified addressable gaps in rheumatology staff’s current processes for addressing high BP and tobacco including both risk identification and facilitating management. Future work should support systems of follow-up, talking points for staff discussions, and or improve staff and provider collaboration on CVD preventive care.
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Table 1. Systems-level barriers and facilitators for blood pressure (BP) & tobacco (TOB) care
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THEME
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ILLUSTRATION
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Step 1. Identification of High BP or Tobacco Use
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Standard check-in routine, time constraints
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BP: “I mean we barely have time to get patients in… and then sometimes the providers come in when we’re still rooming.” |
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Step 2. Follow-Up Within Specialty Clinic |
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No standard follow-up
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BP: “There is no system thing that everybody does…they have come back and were like, ‘Hey, did we ever recheck that blood pressure? I noticed it was really high.’ ‘Well that was like 2 hours ago, and I didn’t know that you wanted me to.’” |
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Physical reminders helped with BP rechecks EHR structure did not support nuance of cutting back. |
BP: “We give our providers stickers, so if it’s a high blood pressure, we could write it on the stickers. I don’t know that we always do though.” |
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Educational materials provided Provider conversations rare |
TOB: “When you give them this packet of [tobacco cessation] paperwork, it’s kind of like ‘Well, we care a little, but we don’t have time to fully follow-up.’” |
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Step 3. Follow-Up Across Settings |
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No standard process for communication with primary care
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TOB: “I usually just say, ‘Do you want any information on quitting?’… And there’s been people who have said yes, but if it’s in a specialty department where their PCP isn’t there, it never gets addressed.” |
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Table 2. Person-level barriers for specialty blood pressure (BP) and tobacco (TOB) care
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THEME
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ILLUSTRATION
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Provider
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Providers’ perception of roles and responsibilities for BP and tobacco management varied
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BP: “But then a lot of times they are like, ‘That’s not my area, primary can take care of that.’” |
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Nurse or medical assistant |
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Knowledge gaps about BP guidelines and tobacco treatments |
BP: “Well they just start asking questions. I’m not the doctor, so I don’t feel like I… just try to down play it.” |
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Staff verbiage needs about BP and tobacco management |
TOB: “I don’t have the verbiage to continue…Even when I tried to say, ‘Are you interested? I have a card’ …I don’t know where to go with it.”
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Patient |
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Knowledge levels varied less knowledgeable about tobacco resources |
BP: “[Patients] ask, ‘Well, what should [my BP] be?’ I hear that all the time.” |
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Patients appeared indifferent talking about BP and resistant during conversations about tobacco |
TOB: “I’ve had, ‘Don’t ask me that ever again’…about if they’re a smoker.” |
To cite this abstract in AMA style:
Tong M, Block L, Gilmore-Bykovskyi A, Ramly E, Bartels CM. Rheumatology Clinic Staff Needs for Partnering to Improve Blood Pressure and Tobacco Risk Management [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/rheumatology-clinic-staff-needs-for-partnering-to-improve-blood-pressure-and-tobacco-risk-management/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatology-clinic-staff-needs-for-partnering-to-improve-blood-pressure-and-tobacco-risk-management/