Background/Purpose: Coronary heart disease (CHD) is increased among patients with rheumatoid arthritis (RA). Limited data suggest that there is a screening gap for hyperlipidemia, a risk factor for CHD, among RA patients. To evaluate the pattern of lipid testing among RA patients based on whether patients are receive care from a primary care physician (PCP), a rheumatologist, or both.

Methods:  We used a dataset that linked commercial and public health plan claims data together over 2006 to 2010. Eligible participants were required to 1) have at least 12 months of continuous medical and pharmacy coverage (baseline), and 2) have 2+ physician diagnosis plus relevant DMARD/biologic medications to categorize them as having RA; 3) 2 years of follow-up. Patients with prevalent myocardial infarction (MI), stroke or CHD during baseline were excluded as well as patients who had baseline diagnosis of hyperlipidemia and/or were already using hyperlipidemia medications The patterns of care at baseline were characterized into 3 categories: 1) visited ONLY PCP; 2) visited ONLY Rheumatologist; 3) visited both rheumatologist AND PCP. We used logistic regression to determine the likelihood of been screened for hyperlipidemia during 2 years of follow-up based on whether RA patients received care from a PCP (only), a rheumatologist (only) or both.

Results: There were 13,319 patients with RA. Overall, 83% were women. The overall age distribution was: 26% 41-60 and 74% >65 years old. There were 18 % of the RA patients who did not see a PCP the 12-month baseline. The proportion of patients that were screened for hyperlipidemia , stratified by physician specialty pattern were: 1) care from a PCP only = 42%; 2) care from a Rheumatologist only = 40%; 3) care from both a rheumatologist AND PCP = 47% . After controlling for multiple potential confounders, there was a 32% increase in the likelihood of being screened for hyperlipidemia if RA patients received combined care between PCPs and rheumatologist (Table).

Conclusion: Screening for hyperlipidemia may not be part of the factors that rheumatologist considered as part of the care of RA patients. Improvement in coordination of care between PCP and rheumatologist s,as well as establishing which physician should be responsible for hyperlipidemia management, may increase appropriate cardiovascular risk factor screening. Table: Likelihood of RA patients being tested for hyperlipidemia in regards to visiting either a rheumatologist or primary care physician