title: Lipid testing in patients with rheumatoid arthritis and key cardiovascular-related comorbidities: a medicare analysis.
abstract: 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.
authors.affiliation: Department of Medicine, Rheumatology Section, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. cb4@medicine.wisc.edu
authors.forename: Christie M
authors.initials: CM
authors.lastname: Bartels
authors.forename: Amy J H
authors.initials: AJ
authors.lastname: Kind
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Thorpe
authors.forename: Christine M
authors.initials: CM
authors.lastname: Everett
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Cook
authors.forename: Patrick E
authors.initials: PE
authors.lastname: McBride
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000453:epidemiology*; D008055:Lipids / Q000097:blood*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D006278:Medicare / Q000706:statistics & numerical data; D011320:Primary Health Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D008055:Lipids