title: The delivery of evidence-based preventive care for older Americans with arthritis.
abstract: BACKGROUND
  Previous research suggests patients with rheumatoid arthritis (RA) may receive suboptimal care with respect to preventive tests and services. We evaluated the proportion of older Americans with RA, psoriatic arthritis (PsA), and osteoarthritis (OA) receiving these services and the specialty of the providers delivering this care.
  
  
  METHODS
  Using data from 1999 to 2006 from the Medicare Chronic Conditions Warehouse, we identified persons age >/= 65 in the national 5% sample. Over the required five-year observation period, we identified tests and services recommended for older adults and the associated healthcare provider. Services of interest included dual energy x-ray absorptiometry (DXA), influenza and pneumococcal vaccination, hyperlipidemia lab testing, mammography and colonoscopy.
  
  
  RESULTS
  After accounting for the sampling fraction, we identified 141,140 RA, 6,300 PsA, and 770,520 OA patients eligible for analysis. Over five years, a majority of RA, PsA, and OA patients were tested for hyperlipidemia (84%, 89% and 87% respectively) and received DXA (69%, 75%, and 52%). Only approximately one-third of arthritis patients received pneumococcal vaccination; 19% to 22% received influenza vaccination each year. Approximately 20% to 35% of arthritis patients never underwent mammography and colonoscopy over five years. Concomitant care from both a rheumatologist and a primary care physician was significantly associated with a greater likelihood of receiving almost all preventive tests and services.
  
  
  CONCLUSIONS
  Among older Americans on Medicare, the absolute proportion of persons with arthritis receiving various recommended preventive services and screening tests was substantially less than 100%. Improved co-management between primary care and arthritis physicians may in part improve the delivery of preventive care for arthritis patients, but novel systematic interventions in this area are needed.
authors.affiliation: Department of Medicine, University of Alabama, Birmingham, Birmingham, AL 35294, USA. jcurtis@uab.edu
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.forename: Tarun
authors.initials: T
authors.lastname: Arora
authors.forename: Pongthorn
authors.initials: P
authors.lastname: Narongroeknawin
authors.forename: Allison
authors.initials: A
authors.lastname: Taylor
authors.forename: Clifton O
authors.initials: CO
authors.lastname: Bingham
authors.forename: Jack
authors.initials: J
authors.lastname: Cush
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Saag
authors.forename: Monika
authors.initials: M
authors.lastname: Safford
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Delzell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001168:Arthritis / Q000517:prevention & control* / Q000628:therapy*; D015535:Arthritis, Psoriatic / Q000517:prevention & control / Q000628:therapy; D001172:Arthritis, Rheumatoid / Q000517:prevention & control / Q000628:therapy; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010003:Osteoarthritis / Q000517:prevention & control / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011315:Preventive Medicine / Q000592:standards*; D014481:United States / Q000453:epidemiology