Objective Despite numerous studies reporting increased cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA), the impact of RA on managing modifiable CVD risk factors remains understudied. We tested the hypothesis that RA is a risk factor for not receiving a hypertension diagnosis. Methods Using a cohort design, we studied adult patients with and without RA/inflammatory arthritis from a large academic multispecialty practice. All were seen regularly in primary care and met clinical guideline hypertension criteria but lacked prior hypertension diagnosis/treatment. The primary outcome was time to ICD-9 code for hypertension or elevated blood pressure, or antihypertensive medication prescription. Kaplan Meier (KM) Survival and Cox proportional hazard modeling were used to examine the impact of RA on diagnosis of hypertension. Results Among 14,974 patients with undiagnosed hypertension, 201 patients had RA codes. RA patients had equivalent primary care visits and more total visits compared to patients without RA. At study end the likelihood of hypertension diagnosis was 36% in RA patients compared to 51% without RA. In adjusted Cox models, RA patients had 29% lower hypertension diagnosis hazard [Hazard Ratio 0.71, 0.55–0.93], reflecting more undiagnosed hypertension than with other comorbidities. Conclusion Among patients meeting guideline-based hypertension criteria, RA patients were less likely to be diagnosed despite more visits than those without RA. Given heightened CVD risks in RA, and the importance of hypertension diagnosis as a first step toward controlling risk, rheumatologists should collaborate to improve rates of diagnosis for this modifiable CVD risk factor.

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.

Overprescribing opioid pain medications has become a major concern in our society due to the increasing rates of substance use disorders and the rate of accidental overdoses. The widespread availability of opioid medications suggests that patients are being prescribed opioids in amounts larger than they require for pain control. Efforts are now being made on a variety of fronts to decrease overprescribing. Material and Methods: A quality-improvement model was applied to address this concern at one medical center in women being discharged from the hospital following childbirth. The rates and amounts at which opioids were prescribed to this population before and after an academic detailing intervention were compared. Results: The overall percentage of women who received prescriptions for opioid medications decreased from 100% to 93% in cesarean sections (P ‫؍‬ .054) and 15% to 9% in vaginal deliveries (P ‫؍‬ .03). The average prescription size decreased by 5 tablets (P < .0001). Implications: Simple quality-improvement methods may have a positive impact on opioid prescribing patterns, including decreasing the percentage of opioids postdelivery or the quantity of opioids per prescription.