Lipid testing in patients with rheumatoid arthritis and key cardiovascular-related comorbidities: a medicare analysis. Semin Arthritis Rheum 2012 Aug;42(1):9-16
Date
03/20/2012Pubmed ID
22424813Pubmed Central ID
PMC3404199DOI
10.1016/j.semarthrit.2012.01.005Scopus ID
2-s2.0-84864103185 (requires institutional sign-in at Scopus site) 27 CitationsAbstract
OBJECTIVE: For patients with rheumatoid arthritis (RA) and comorbid cardiovascular disease (CVD), diabetes, or hyperlipidemia, annual lipid testing is recommended to reduce morbidity and mortality from comorbidities. Given trends encouraging complex patients to receive care in "medical homes," we examined associations between regularly seeing a primary care provider (PCP) and lipid testing in RA patients with cardiovascular-related comorbidities.
METHODS: We performed a retrospective cohort study examining a 5% random USA Medicare sample (2004-06) of beneficiaries over 65 years old with RA and concomitant CVD, diabetes, or hyperlipidemia (n = 16,893). We examined the relationship between receiving lipid testing in 2006 and having at least 1 PCP visit per year in 2004, 2005, and 2006 using multivariate regression.
RESULTS: Ninety percent of patients had prevalent CVD; 46% had diabetes, and 64% had hyperlipidemia. However, annual lipid testing was only performed in 63% of these RA patients. Thirty percent of patients saw a PCP less than once per year, despite frequent visits (mean >9) with other providers. Patients without at least 1 annual PCP visit were 16% less likely to have lipid testing. Increased age, complexity scores, hospitalization, and large town residence predicted decreased lipid testing.
CONCLUSIONS: Despite comorbid CVD, diabetes, or hyperlipidemia, 30% of Medicare RA patients saw a PCP less than once per year, and 1 in 3 lacked annual lipid testing. Findings support advocating primary care visits at least once per year. Remaining gaps in lipid testing suggest the need for additional strategies to improve lipid testing in at-risk RA patients.
Author List
Bartels CM, Kind AJ, Thorpe CT, Everett CM, Cook RJ, McBride PE, Smith MAAuthor
Christine M. Everett PhD, PAC Chief, Director, Professor in the Health Sciences Education department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Arthritis, Rheumatoid
Cardiovascular Diseases
Comorbidity
Diabetes Mellitus
Female
Humans
Hyperlipidemias
Lipids
Male
Mass Screening
Medicare
Primary Health Care
Retrospective Studies
United States
