title: Rheumatologist and Primary Care Management of Cardiovascular Disease Risk in Rheumatoid Arthritis: Patient and Provider Perspectives.
abstract: OBJECTIVE
  Despite increased cardiovascular disease (CVD) risk, rheumatoid arthritis (RA) patients often lack CVD preventive care. We examined CVD preventive care processes from RA patient and provider perspectives to develop a process map for identifying targets for future interventions to improve CVD preventive care.
  
  
  METHODS
  Thirty-one participants (15 patients, 7 rheumatologists, and 9 primary care physicians [PCPs]) participated in interviews that were coded using NVivo software and analyzed using grounded theory techniques.
  
  
  RESULTS
  Patients and providers reported that receipt of preventive care depends upon identifying and acting on risk factors, although most noted that both processes rarely occurred. Engagement in these processes was influenced by various provider-, system-, visit-, and patient-related conditions, such as patient activation or patients' knowledge about their risk. While nearly half of patients and PCPs were unaware of RA-CVD risk, all rheumatologists were aware of risk. Rheumatologists reported not systematically identifying risk factors, or, if identified, they described communicating about CVD risk factors via clinic notes to PCPs instead of acting directly due to perceived role boundaries. PCPs suggested that scheduling PCP visits could improve CVD risk management, and all participants viewed comanagement positively.
  
  
  CONCLUSIONS
  Findings from this study illustrate important gaps and opportunities to support identifying and acting on CVD risk factors in RA patients from the provider, system, visit, and patient levels. Future work should investigate professional role support through improved guidelines, patient activation, and system-based RA-CVD preventive care strategies.
authors: University of Wisconsin, Madison.
authors: Christie M
authors: CM
authors: Bartels
authors: University of Wisconsin, Madison.
authors: Tonya J
authors: TJ
authors: Roberts
authors: University of Wisconsin, Madison.
authors: Karen E
authors: KE
authors: Hansen
authors: University of Wisconsin, Madison.
authors: Elizabeth A
authors: EA
authors: Jacobs
authors: University of Wisconsin, Madison.
authors: Andrea
authors: A
authors: Gilmore
authors: University of Wisconsin, Madison.
authors: Courtney
authors: C
authors: Maxcy
authors: University of Wisconsin, Madison.
authors: Barbara J
authors: BJ
authors: Bowers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010361:Patients / Q000523:psychology*; D010465:Perception; D058007:Physicians, Primary Care / Q000523:psychology* / Q000592:standards; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000592:standards; D011320:Primary Health Care / Q000592:standards; D011379:Prognosis; D058996:Quality Improvement; D012219:Rheumatology / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult