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Brandt J, Ramly E, Lim SS, Bao G, Messina ML, Piper ME, Bartels CM. Implementing a Staff-Led Smoking Cessation Intervention in a Diverse Safety-Net Rheumatology Clinic: A Pre-Post Scalability Study in a Low-Resource Setting. Arthritis Care Res (Hoboken) 2024; 76:1342-1350. [PMID: 38622089 PMCID: PMC11349476 DOI: 10.1002/acr.25349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Quit Connect (QC), our specialty clinic smoking cessation intervention, supports clinic staff to check, advise, and connect willing patients to a state quit line or class. QC improved tobacco screening and quit line referrals 26-fold in a predominantly White academic health care system population. Implementing QC includes education, electronic health record (EHR) reminders, and periodic audit feedback. This study tested QC's feasibility and impact in a safety-net rheumatology clinic with a predominantly Black population. METHODS In this pre-post study, adult rheumatology visits were analyzed 12 months before through 18 months after QC intervention (November 2019 through November 2021, omitting COVID-19 peak April through November 2020). EHR data compared process and clinical outcomes, including offers, referrals to resources, completed referrals, and documented cessation. Clinic staff engaged in pre-post focus groups and questionnaires regarding intervention feasibility and acceptability. Cost-effectiveness was also assessed. RESULTS Visit-level patients who smoked were 89.8% Black and 69.5% women (n = 550). Before intervention, clinic staff rarely asked patients about readiness to cut back smoking (<10% assessment). After QC intervention, staff assessed quit readiness in 31.8% of visits with patients who smoked (vs 8.1% before); 58.9% of these patients endorsed readiness to cut back or quit. Of 102 accepting cessation services, 37% (n = 17) of those reached set a quit date. Staff found the intervention feasible and acceptable. Each quit attempt cost approximately $4 to $10. CONCLUSION In a safety-net rheumatology clinic with a predominantly Black population, QC improved tobacco screening, readiness-to-quit assessment, and referrals and was also feasible and cost-effective.
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Affiliation(s)
- Jennifer Brandt
- Emory University School of Medicine and Grady Health System, Atlanta, Georgia
| | - Edmond Ramly
- University of Wisconsin School of Medicine and Public Health and University of Wisconsin College of Engineering, Madison
- Indiana University School of Public Health, Bloomington, Indiana
| | - S Sam Lim
- Emory University School of Medicine and Grady Health System, Atlanta, Georgia
| | - Gaobin Bao
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Megan E Piper
- UW Center for Tobacco Research and Intervention, Madison, Wisconsin
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England BR, Smith BJ, Baker NA, Barton JL, Oatis CA, Guyatt G, Anandarajah A, Carandang K, Constien D, Chan KK, Davidson E, Dodge CV, Bemis-Dougherty A, Everett S, Fisher N, Fraenkel L, Goodman SM, Lewis J, Menzies V, Moreland LW, Navarro-Millan I, Patterson S, Phillips L“R, Shah N, Singh N, White D, AlHeresh R, Barbour KE, Bye T, Guglielmo D, Haberman R, Johnson T, Kleiner A, Lane CY, Li LC, Master H, Pinto D, Poole JL, Steinbarger K, Sztubinski D, Thoma L, Tsaltskan V, Turgunbaev M, Wells C, Turner AS, Treadwell JR. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Rheumatol 2023; 75:1299-1311. [PMID: 37227071 PMCID: PMC10947582 DOI: 10.1002/art.42507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To develop initial American College of Rheumatology (ACR) guidelines on the use of exercise, rehabilitation, diet, and additional interventions in conjunction with disease-modifying antirheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis (RA). METHODS An interprofessional guideline development group constructed clinically relevant Population, Intervention, Comparator, and Outcome (PICO) questions. A literature review team then completed a systematic literature review and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the certainty of evidence. An interprofessional Voting Panel (n = 20 participants) that included 3 individuals with RA achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS The Voting Panel achieved consensus on 28 recommendations for the use of integrative interventions in conjunction with DMARDs for the management of RA. Consistent engagement in exercise received a strong recommendation. Of 27 conditional recommendations, 4 pertained to exercise, 13 to rehabilitation, 3 to diet, and 7 to additional integrative interventions. These recommendations are specific to RA management, recognizing that other medical indications and general health benefits may exist for many of these interventions. CONCLUSION This guideline provides initial ACR recommendations on integrative interventions for the management of RA to accompany DMARD treatments. The broad range of interventions included in these recommendations illustrates the importance of an interprofessional, team-based approach to RA management. The conditional nature of most recommendations requires clinicians to engage persons with RA in shared decision-making when applying these recommendations.
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Affiliation(s)
- Bryant R. England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE
| | | | | | - Jennifer L. Barton
- VA Portland Health Care System and Oregon Health & Science University, Portland, OR
| | | | | | | | | | | | | | | | - Carole V. Dodge
- University of Michigan Hospital and Health System, Ann Arbor, MI
| | | | - Sotiria Everett
- Department of Family, Population, Preventive Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY
| | | | | | | | | | | | | | | | - Sarah Patterson
- UCSF Osher Center for Integrative Medicine, San Francisco, CA
| | | | | | | | | | | | | | | | | | | | - Tate Johnson
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE
| | | | - Chris Y. Lane
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Linda C. Li
- University of British Columbia and Arthritis Research Canada, Vancouver, BC, Canada
| | - Hiral Master
- Vanderbilt University Medical Center, VICTR, Nashville, TN
| | | | | | | | | | - Louise Thoma
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Bartels CM, Johnson L, Ramly E, Panyard DJ, Gilmore-Bykovskyi A, Johnson HM, McBride P, Li Z, Sampene E, Lauver DR, Lewicki K, Piper ME. Impact of a Rheumatology Clinic Protocol on Tobacco Cessation Quit Line Referrals. Arthritis Care Res (Hoboken) 2022; 74:1421-1429. [PMID: 33825349 PMCID: PMC8492788 DOI: 10.1002/acr.24589] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/23/2020] [Accepted: 03/02/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Smoking increases cardiopulmonary and rheumatic disease risk, yet tobacco cessation intervention is rare in rheumatology clinics. This study aimed to implement a rheumatology staff-driven protocol, Quit Connect, to increase the rate of electronic referrals (e-referrals) to free, state-run tobacco quit lines. METHODS We conducted a quasi-experimental cohort study of Quit Connect at 3 rheumatology clinics comparing tobacco quit line referrals from 4 baseline years to referrals during a 6-month intervention period. Nurses and medical assistants were trained to use 2 standardized electronic health record (EHR) prompts to check readiness to quit smoking within 30 days, advise cessation, and connect patients using tobacco quit line e-referral orders. Our objective was to use EHR data to examine the primary outcome of tobacco quit line referrals using pre/post design. RESULTS Across 54,090 pre- and post-protocol rheumatology clinic visits, 4,601 were with current smokers. We compared outcomes between 4,078 eligible pre-implementation visits and 523 intervention period visits. Post-implementation, the odds of tobacco quit line referral were 26-fold higher compared to our pre-implementation rate (unadjusted odds ratio [OR] 26 [95% confidence interval (95% CI) 6-106]). Adjusted odds of checking readiness to quit in the next 30 days increased over 100-fold compared to pre-implementation (adjusted OR 132 [95% CI 99-177]). Intervention led to e-referrals for 71% of quit-ready patients in <90 seconds; 24% of referred patients reported a quit attempt. CONCLUSION Implementing Quit Connect in rheumatology clinics was feasible and improved referrals to a state-run tobacco quit line. Given the importance of smoking cessation to reduce cardiopulmonary and rheumatic disease risk, future studies should investigate disseminating cessation protocols like Quit Connect that leverage tobacco quit lines.
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Affiliation(s)
| | - Lauren Johnson
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Edmond Ramly
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Daniel J Panyard
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Heather M Johnson
- Charles E. Schmidt College of Medicine, Florida Atlantic University and Boca Raton Regional Hospital/Baptist Health South Florida, Boca Raton
| | - Patrick McBride
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Zhanhai Li
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Emmanuel Sampene
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Kristin Lewicki
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Megan E Piper
- University of Wisconsin School of Medicine and Public Health, Madison
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Izadi Z, Schmajuk G, Gianfrancesco M, Subash M, Evans M, Trupin L, Yazdany J. Significant Gains in Rheumatoid Arthritis Quality Measures Among RISE Registry Practices. Arthritis Care Res (Hoboken) 2022; 74:219-228. [PMID: 32937026 PMCID: PMC7960552 DOI: 10.1002/acr.24444] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/21/2020] [Accepted: 09/08/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Using the American College of Rheumatology Rheumatology Informatics System for Effectiveness (RISE) registry, our objective was to examine performance on rheumatoid arthritis (RA) quality measures and to assess the association between practice characteristics and changes in performance over time among participating practices. METHODS We analyzed data from practices enrolled in RISE between January 1, 2015 and December 31, 2017. Eight quality measures in the areas of RA disease management, cardiovascular risk reduction, and patient safety were examined. Variability in performance was evaluated at the practice level. Multivariate linear models were used to predict change in measure performance by year and to determine the effect of practice characteristics on change in performance over time. RESULTS Data from 59,986 patients from 54 practices were examined. The mean ± SD age was 62 ± 14 years, 77% were female, 69% were Caucasian, and most patients were seen in a single-specialty group practice (46%). The average performance on measures related to RA treatments was consistently high (>90%) across the study period. Measures related to RA functional status and disease activity assessment had the greatest improvements over time (8.4% and 13.0% increase per year, respectively; P < 0.001). Single-specialty group practices had the fastest rates of improvement over time across all measures. CONCLUSION Among practices participating in RISE between 2015 and 2017, performance on most RA quality measures improved. Single-specialty group practices saw the fastest rates of improvement over time. Identification of workflow patterns leading to dramatic improvements in quality of care will help guide process redesign to address gaps in priority areas, such as tuberculosis screening and blood pressure control.
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Affiliation(s)
| | - Gabriela Schmajuk
- San Francisco Veterans Affairs Medical Center and University of California, San Francisco
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Ramly E, Lauver DR, Gilmore-Bykovskyi A, Bartels CM. Interactive and Participatory Audit and Feedback (IPAF): theory-based development and multi-site implementation outcomes with specialty clinic staff. Implement Sci Commun 2021; 2:58. [PMID: 34059154 PMCID: PMC8167954 DOI: 10.1186/s43058-021-00155-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 05/04/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Theory-based implementation strategies, such as audit and feedback (A&F), can improve the adoption of evidence-based practices. However, few strategies have been developed and tested to meet the needs of specialty clinics. In particular, frontline staff can execute cardiovascular disease (CVD) risk reduction protocols, but A&F strategies to support them are not well examined. Our objective was to develop and evaluate a theory-based approach to A&F, Interactive and Participatory A&F (IPAF). METHODS We developed IPAF informed by two complementary theories, self-regulation theory (SRT) and self-determination theory (SDT). IPAF applies concepts from these theories to inform (1) what to address with staff to improve rates of best practices (SRT) and (2) how to interact with staff to improve behaviors aligned with best practices (SDT). We promoted IPAF fidelity by developing a semi-structured guide to facilitate staff discussion of target behaviors, perceived barriers, goals, and action plans. We evaluated IPAF in the context of eight quasi-experimental implementations in specialty clinics across two health systems. Following a hybrid type 2 effectiveness-implementation design, we reported intervention outcomes for CVD risk reduction elsewhere. This paper reports implementation outcomes associated with IPAF, focusing on feasibility, appropriateness, acceptability, fidelity, and adoption. We evaluated implementation outcomes using mixed-methods data including electronic health record (EHR) data, team records, and staff questionnaire responses. RESULTS Eighteen staff participated in 99 monthly, individual, synchronous (face-to-face or phone) IPAF sessions during the first 6 months of implementation. Subsequently, we provided over 375 monthly feedback emails. Feasibility data revealed high staff attendance (90-93%) and engagement in IPAF sessions. Staff highly rated questionnaire items about IPAF acceptability. Team records and staff responses demonstrated fidelity of IPAF delivery and receipt. Adoption of target behaviors increased significantly (all P values < 0.05), and adoption or behaviors were maintained for over 24 months. CONCLUSIONS We developed and evaluated a theory-based approach to A&F with frontline staff in specialty clinics to improve the implementation of evidence-based interventions. The findings support feasibility, appropriateness, acceptability, and fidelity of IPAF, and staff adoption and maintenance of target behaviors. By evaluating multi-site implementation outcomes, we extended prior research on clinic protocols and A&F beyond primary care settings and providers.
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Affiliation(s)
- Edmond Ramly
- Department of Family and Community Medicine, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI, USA.,Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Diane R Lauver
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Christie M Bartels
- Department of Medicine, School of Medicine & Public Health, University of Wisconsin-Madison, 1685 Highland Ave, Rm 4132, Madison, WI, 53705-2281, USA.
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Karacabeyli D, Shojania K, Dehghan N, Lacaille D. Rheumatology health care providers' views and practices on obesity and smoking cessation management in rheumatoid arthritis. Clin Rheumatol 2021; 40:2681-2688. [PMID: 33517485 DOI: 10.1007/s10067-021-05607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess rheumatology health care providers' (HCPs) knowledge, beliefs, self-efficacy, practices, and perceived barriers pertaining to weight management and smoking cessation counselling in patients with rheumatoid arthritis (RA). METHOD We administered an online survey to collect self-reported data on rheumatology HCPs' knowledge, beliefs, self-efficacy, perceived barriers, and practices related to weight management and smoking cessation counselling. Participants were recruited through invitation emails (with anonymous survey links) sent by three Canadian rheumatology organizations. RESULTS Fifty-nine rheumatology HCPs (15 nurses, 44 physicians) completed the survey (response rate: 11%). Over 85% correctly identified associations between obesity, or smoking, and more severe or active RA, as well as poorer response to treatment. All but one participant agreed that it was part of their responsibility to discuss these issues with patients, but 78% (46/59) felt not or slightly confident in their ability to help patients quit smoking or achieve clinically significant weight loss. The majority did not routinely assist patients in accessing appropriate resources or providers (only 42% did for obesity, 36% for smoking), send referrals (2-44%, depending on referral), or offer relevant educational materials (15% for obesity, 20% for smoking). Common barriers included competing demands and lack of time, training, access to expertise, and knowledge of available programs. CONCLUSION Most rheumatology HCPs understood the implications of cigarette smoking and obesity in RA and accepted responsibility in addressing these issues. However, they lacked the time, training, confidence, and knowledge of local resources to do so effectively. There is a need to bridge this gap. Key Points • Training through medical and nursing school as well as residency on weight management and smoking cessation counselling was nearly unanimously described as poor or fair. • Most rheumatology health care providers understood the implications of cigarette smoking and obesity in rheumatoid arthritis and accepted responsibility in addressing these issues; however, they lacked the time, training, confidence, and knowledge of local resources to do so effectively. • There is a need to bridge the gap between health care providers' intentions and actions, and this may include the development of guides outlining local weight management and smoking cessation expertise, programs, referral processes, and educational materials.
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Affiliation(s)
- Derin Karacabeyli
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kam Shojania
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, 5591 Number 3 Rd, Richmond, British Columbia, BC V6X 2C7, Canada
| | - Natasha Dehghan
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, 5591 Number 3 Rd, Richmond, British Columbia, BC V6X 2C7, Canada
| | - Diane Lacaille
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. .,Arthritis Research Canada, 5591 Number 3 Rd, Richmond, British Columbia, BC V6X 2C7, Canada.
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Schletzbaum M, Wang X, Greenlee R, Piper ME, Bartels CM. Predictors of Smoking Cessation in Patients With Rheumatoid Arthritis in Two Cohorts: Most Predictive Health Care Factors. Arthritis Care Res (Hoboken) 2020; 73:633-639. [PMID: 32128996 DOI: 10.1002/acr.24154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recognizing smoking as a risk factor for rheumatoid arthritis (RA) severity, the present study was undertaken to evaluate patient- and health care-level predictors of smoking cessation in patients with RA to guide implementation of smoking cessation interventions. METHODS Electronic health record data from 2 health systems were abstracted for patients with at least 2 International Classification of Disease diagnosis codes for RA between 2005 and 2016. Patients missing smoking statuses or with <6 months of follow-up were excluded. Multivariable logistic regression was used to determine predictors of smoking cessation. RESULTS Among 3,577 patients with RA, 507 smoked at baseline, and 29% quit over a median of 4.75 years. Black male patients, ages 40-59 years and enrolled in Medicaid, were significantly more likely to be baseline smokers; however, none of these factors predicted cessation. Instead, patients new to rheumatology care were 60% more likely to quit (adjusted odds ratio [ORadj ] 1.60 [95% confidence interval (95% CI) 1.02-2.50]), and patients in the rural community health system were 66% more likely to quit (ORadj 1.66 [95% CI 1.03-2.69]). Seropositive patients were 43% less likely to quit smoking (ORadj 0.57 [95% CI 0.35-0.91]). CONCLUSION Health care factors, including health system and being new to rheumatology care, were more predictive of smoking cessation in patients with RA than patient sociodemographic factors, suggesting an important role for health system cessation efforts for patients with RA. Seropositive patients were less likely to quit and may particularly benefit from cessation support. Emphasizing smoking cessation with new or seropositive RA patients and leveraging health system interventions could improve smoking cessation and outcomes in RA.
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Affiliation(s)
- Maria Schletzbaum
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Xing Wang
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Megan E Piper
- University of Wisconsin School of Medicine and Public Health, Madison
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Hedman L, Katsaounou PA, Filippidis FT, Ravara SB, Lindberg A, Janson C, Gratziou C, Rohde G, Kyriakos CN, Mons U, Fernández E, Trofor AC, Demjén T, Przewoźniak K, Tountas Y, Fong GT, Vardavas CI. Receiving support to quit smoking and quit attempts among smokers with and without smoking related diseases: Findings from the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2019; 16:A14. [PMID: 31516468 PMCID: PMC6661851 DOI: 10.18332/tid/102787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/11/2019] [Accepted: 01/12/2019] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Having a chronic disease either caused or worsened by tobacco smoking does not always translate into quitting smoking. Although smoking cessation is one of the most cost-effective medical interventions, it remains poorly implemented in healthcare settings. The aim was to examine whether smokers with chronic and respiratory diseases were more likely to receive support to quit smoking by a healthcare provider or make a quit attempt than smokers without these diseases. METHODS This population-based study included a sample of 6011 adult smokers in six European countries. The participants were interviewed face-to-face and asked questions on sociodemographic characteristics, current diagnoses for chronic diseases, healthcare visits in the last 12 months and, if so, whether they had received any support to quit smoking. Questions on smoking behavior included nicotine dependence, motivation to quit smoking and quit attempts in the last 12 months. The results are presented as weighted percentages with 95% confidence intervals (CI) and as adjusted odds ratios with 95% CI based on logistic regression analyses. RESULTS Smokers with chronic respiratory disease, those aged 55 years and older, as well as those with one or more chronic diseases were more likely to receive smoking cessation advice from a healthcare professional. Making a quit attempt in the last year was related to younger age, high educational level, higher motivation to quit, lower nicotine dependence and having received advice to quit from a healthcare professional but not with having chronic diseases. There were significant differences between countries with smokers in Romania consistently reporting more support to quit as well as quit attempts. CONCLUSIONS Although smokers with respiratory disease did indeed receive smoking cessation support more often than smokers without disease, many smokers did not receive any advice or support to quit during a healthcare visit.
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Affiliation(s)
- Linnea Hedman
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
- Contributed equally
| | - Paraskevi A. Katsaounou
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- National and Kapodistrian University of Athens (UoA), Athens, Greece
- Contributed equally
| | - Filippos T. Filippidis
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- National and Kapodistrian University of Athens (UoA), Athens, Greece
- Department of Primary Care and Public Health, Imperial College, London, United Kingdom
| | - Sofia B. Ravara
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- Health Sciences Research Centre (CICS-UBI), Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal
- Public Health Research Centre, National School of Public Health, NOVA University, Lisbon, Portugal
| | - Anne Lindberg
- Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Christer Janson
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Christina Gratziou
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Gernot Rohde
- Medical Clinic I, Department of Respiratory Medicine, Goethe University Hospital, Frankfurt, Germany
| | - Christina N. Kyriakos
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Esteve Fernández
- Institut Català d’Oncologia and Bellvitge Biomedical Research Institute (IDIBELL), Catalonia, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, Catalonia, Spain
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Krzysztof Przewoźniak
- Health Promotion Foundation (HPF), Warsaw, Poland
- Maria Skłodowska-Curie Institute-Oncology Center (MSCI), Warsaw, Poland
| | - Yannis Tountas
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Geoffrey T. Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Constantine I. Vardavas
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
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Bartels CM, Johnson H, Alcaraz Voelker K, Ogdie A, McBride P, Jacobs EA, Zhao YQ, Smith M. Frequency and Predictors of Communication About High Blood Pressure in Rheumatoid Arthritis Visits. J Clin Rheumatol 2018; 24:210-217. [PMID: 29688897 PMCID: PMC5962363 DOI: 10.1097/rhu.0000000000000726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND/OBJECTIVE Given heightened cardiovascular disease (CVD) risk in rheumatoid arthritis (RA) and that higher blood pressure (BP) represents greater CVD risk, we hypothesized that higher BP would predict more BP-related communication in rheumatology visits. We examined predictors of documented BP communication during RA clinic visits. METHODS This was a retrospective cohort study of RA patients identified in electronic health record records with uncontrolled hypertension (HTN) receiving both primary and rheumatology care. Trained abstractors reviewed RA visit notes for "BP communication" using a standardized tool to elicit documentation about BP or HTN beyond recording vital signs. We used multivariate logistic regression to examine the impact of BP category (American Heart Association: ideal normotension, pre-HTN, and stages I and II HTN) on odds ratios (95% confidence intervals) of BP communication. RESULTS Among 1267 RA patients, 40% experienced BP elevations meeting the definition of uncontrolled HTN. Of 2677 eligible RA visits, 22% contained any documented BP communication. After adjustment, models predicted only 31% of visits with markedly high BPs 160/100 mm Hg or greater would contain BP communication. Compared with stage I, stage II elevation did not significantly increase communication (odds ratio, 2.0 [95% confidence interval, 1.4-2.8] vs. 1.5 [1.2-2.2]), although both groups' odds exceeded pre-HTN and normotension. Less than 10% of eligible visits resulted in documented action steps recommending follow-up of high BP. CONCLUSIONS Regardless of BP magnitude, most RA clinic visits lacked documented communication about BP despite compounded CVD risk. Future work should study how rheumatology clinics can facilitate follow-up of high BPs to address HTN as the most common and reversible CVD risk factor.
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Affiliation(s)
| | | | | | - Alexis Ogdie
- Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | - Ying-Qi Zhao
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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