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Abstract Number: 1493

Screening Patterns for Hyperlipidemia Among Patients with Rheumatoid Arthritis Based on Patterns of Care from By Primary Care Physicians, Rheumatologists or Both

Iris Navarro-Millán1, Shuo Yang2, Lang Chen2, Huifeng Yun3, Christie M. Bartels4, Aprajita Jagpal1, Andrea Cherrington5, Liana Fraenkel6, Monika M. Safford7 and Jeffrey Curtis8, 1Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 2Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 3Epidemiology, University of Alabama at Birmingham, Birmingham, AL, 4Rheumatology/Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 5Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, 6Yale University School of Medicine, New Haven, CT, 7Weill Cornell Medical College, New York, NY, 8Division Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, AL

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Rheumatoid arthritis (RA)

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Session Information

Date: Monday, November 14, 2016

Session Title: Rheumatoid Arthritis – Clinical Aspects - Poster II: Co-morbidities and Complications

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

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

Characteristic

% tested for hyperlipidemia

Unadjusted (95% CI)

Adjusted* (95% CI)

All patients, N  5932 (44.5) 13,319 13,319
Rheum only [referent] 40.0 Ref Ref
PCP only 41.9 1.08 (0.97,1.20) 1.07 (0.96,1.20)
PCP + Rheum 46.9 1.32 (1.21,1.45) 1.32 (1.20,1.45)
*adjusted for age category, sex, race, comorbidity index, and RA medication use


Disclosure: I. Navarro-Millán, None; S. Yang, None; L. Chen, None; H. Yun, None; C. M. Bartels, None; A. Jagpal, None; A. Cherrington, None; L. Fraenkel, None; M. M. Safford, None; J. Curtis, Roche/Genentech, UCB, Janssen, Corrona, Amgen, Pfizer, BMS, Crescendo, AbbVie, 2,Roche/Genentech, UCB, Janssen, Corrona, Amgen, Pfizer, BMS, Crescendo, AbbVie, 5.

To cite this abstract in AMA style:

Navarro-Millán I, Yang S, Chen L, Yun H, Bartels CM, Jagpal A, Cherrington A, Fraenkel L, Safford MM, Curtis J. Screening Patterns for Hyperlipidemia Among Patients with Rheumatoid Arthritis Based on Patterns of Care from By Primary Care Physicians, Rheumatologists or Both [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/screening-patterns-for-hyperlipidemia-among-patients-with-rheumatoid-arthritis-based-on-patterns-of-care-from-by-primary-care-physicians-rheumatologists-or-both/. Accessed December 7, 2019.
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