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Abstract
BackgroundDespite high risk for cardiovascular disease (CVD) mortality, screening and treatment of hyperlipidemia in patients with rheumatoid arthritis (RA) is suboptimal. We asked primary care physicians (PCPs) and rheumatologists to identify barriers to screening and treatment for hyperlipidemia among patients with RA.MethodsWe recruited rheumatologists and PCPs nationally to participate in separate moderated structured group teleconference discussions using the nominal group technique. Participants in each group generated lists of barriers to screening and treatment for hyperlipidemia in patients with RA, then each selected the three most important barriers from this list. The resulting barriers were organized into physician-, patient- and system-level barriers, informed by the socioecological framework.ResultsTwenty-seven rheumatologists participated in a total of 3 groups (group size ranged from 7 to 11) and twenty PCPs participated in a total of 3 groups (group size ranged from 4 to 9). Rheumatologists prioritized physician level barriers (e.g. ‘ownership’ of hyperlipidemia screening and treatment), whereas PCPs prioritized patient-level barriers (e.g. complexity of RA and its treatments).ConclusionRheumatologists were conflicted about whether treatment of CVD risk among patients with RA should fall within the role of the rheumatologist or the PCP. All participating PCPs agreed that CVD risk reduction was within their role. Factors that influenced PCPs’ decisions for screening and treatment for CVD risk in patients with RA were mainly related to their concern about how treatment for CVD risk could influence RA symptomatology (myalgia from statins) or how inflammation from RA and RA medications influences lipid profiles.
Highlights
Despite high risk for cardiovascular disease (CVD) mortality, screening and treatment of hyperlipidemia in patients with rheumatoid arthritis (RA) is suboptimal
The final sample was 27 rheumatologists who participated in three groups of eleven, eight, and seven participants each, respectively; and 20 primary care physicians (PCPs) who participated in three groups of seven, four, and nine participants each, respectively
Many rheumatologists in this study expressed that management of CVD risk among their patients with RA does not fall within their role
Summary
Despite high risk for cardiovascular disease (CVD) mortality, screening and treatment of hyperlipidemia in patients with rheumatoid arthritis (RA) is suboptimal. Patients with rheumatoid arthritis (RA) are at high risk for cardiovascular disease (CVD) [1,2,3,4,5], and experience approximately 50% higher CVD mortality compared to the general population [5]. One qualitative study among rheumatologists, primary care providers (PCPs), and patients with RA found that lack of knowledge about increased CVD risk in the population was common [12]. Since their focus was on CVD risk reduction overall (e.g. diabetes screening, hypertension, smoking, cholesterol level screening), it could not shed light on the low rates of lipid testing [12]. The goal of this study was to learn about barriers to lipid testing among RA patients, from the perspective of both rheumatologists and PCPs
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