title: Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada.
abstract: Quality measurement for rheumatoid arthritis (RA) patients has largely focused on care provided by rheumatologists. Our aim was to develop and assess quality measures related to the screening and management of comorbidity in RA patients in primary care.
  
  
  
  We used the primary care Electronic Medical Record Administrative data Linked Database in Ontario, Canada. We harmonized Canadian general population and RA clinical recommendations to develop and assess screening, process, and outcome measures. For each RA patient, 10 non-RA patients were matched by age and sex. Stratified analyses were performed, comparing patients with RA to those without RA, to assess the performance of quality measures.
  
  
  
  We compared 1,405 RA patients to 14,050 matched non-RA patients (72.8% female; mean age 62.5 years). Compared to non-RA patients, RA patients more frequently had influenza (44.9% versus 40.0%) and pneumococcal (40.4% versus 34.1%) vaccinations and bone mineral density testing (67.4% versus 58.1%). Herpes zoster vaccinations were less frequent among RA patients (13.8% versus 19.5%), as was screening for cervical cancer (58.6% versus 64.0%). No significant differences were observed between RA and non-RA patients in screenings for breast (70.7% versus 73.8%) or colorectal (31.7% versus 34.5%) cancers. Only a quarter of RA patients had a comprehensive cardiovascular risk assessment. No definitive differences were detected in the management of patients who had co-occurring cardiovascular disease or diabetes mellitus.
  
  
  
  For both RA and non-RA patients, compliance with Canadian recommendations for preventive medical services and screening for comorbid conditions in primary care was less than optimal. This indicates key targets for improvement.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, and Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada.
authors.forename: Jessica
authors.identifier: 0000-0002-7464-0460
authors.initials: J
authors.lastname: Widdifield
authors.affiliation: Institute for Clinical Evaluative Sciences, University of Toronto, and Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Noah M
authors.initials: NM
authors.lastname: Ivers
authors.affiliation: Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.affiliation: Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Liisa
authors.initials: L
authors.lastname: Jaakkimainen
authors.affiliation: University of Toronto and University Health Network, Toronto, Ontario, Canada.
authors.forename: Claire
authors.initials: C
authors.lastname: Bombardier
authors.affiliation: University of Toronto, Toronto, Ontario, Canada, and Southlake Regional Health Centre, Newmarket, Ontario, Canada.
authors.forename: J Carter
authors.initials: JC
authors.lastname: Thorne
authors.affiliation: William Osler Health Centre, Brampton, Ontario, Canada.
authors.forename: Vandana
authors.initials: V
authors.lastname: Ahluwalia
authors.affiliation: Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada, and McMaster University, Hamilton, Ontario, Canada.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Young
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Wing
authors.affiliation: Institute for Clinical Evaluative Sciences, University of Toronto, Sunnybrook Health Sciences Centre, and University Health Network, Toronto, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Tu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003141:Communicable Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D057286:Electronic Health Records; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D009864:Ontario / Q000453:epidemiology; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011320:Primary Health Care; D017064:Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult