Frequency and Predictors of Communication About High Blood Pressure in Rheumatoid Arthritis Visits

Bartels, Christie M.; Johnson, Heather M.; Voelker, Katya Alcaraz; Ogdie, Alexis; McBride, Patrick E.; Jacobs, Elizabeth A.; Zhao, Ying‐Qi; Smith, Maureen A.

doi:10.1097/rhu.0000000000000726

Cited by 10 publications

(10 citation statements)

References 34 publications

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“…High blood pressure (BP) is the most prevalent and reversible cardiovascular disease (CVD) risk factor among all adults, (1) with even higher risk in rheumatology patients like those with rheumatoid arthritis (RA). (2, 3) Still, we reported that only 10% of eligible RA visits recommended follow-up of high BP (4) and that RA patients were less likely to have their hypertension diagnosed than peers meeting identical longitudinal BP thresholds. (5) Treating high BP in 11 at-risk patients could prevent one CVD event, (6) yet half of US adults with hypertension lack BP control.…”

Section: Conclusion-implementing the Bp Connect Specialty Clinic Protocol In Rheumatology Clinicsmentioning

confidence: 91%

Connecting Rheumatology Patients to Primary Care for High Blood Pressure: Specialty Clinic Protocol Improves Follow‐up and Population Blood Pressures

Bartels

Ramly

Johnson

et al. 2019

Arthritis Care & Research

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Section: Conclusion-implementing the Bp Connect Specialty Clinic Protocol In Rheumatology Clinicsmentioning

confidence: 91%

Connecting Rheumatology Patients to Primary Care for High Blood Pressure: Specialty Clinic Protocol Improves Follow‐up and Population Blood Pressures

Bartels

Ramly

Johnson

et al. 2019

Arthritis Care & Research

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“…All patients were ≥20 years old and seen regularly for primary and rheumatology care (≥2 health system visits with at least one primary care visit in 24 months) and had rheumatology clinic notes clearly documenting rheumatoid arthritis in the absence of another specific inflammatory arthritis diagnosis (Figure 1). One cohort included RA patients with prevalent hypertension [12] according to Electronic Health Record (EHR) algorithms using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) [13]. The second cohort included patients who were eligible for cholesterol screening or control [14, 15].…”

Section: Methodsmentioning

confidence: 99%

Rheumatologists Modestly More Likely to Counsel Smokers in Visits Without Rheumatoid Arthritis Control

Vreede¹,

Johnson²,

Piper³

et al. 2017

J Clin Rheumatol

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Background Among patients with rheumatoid arthritis (RA), smoking increases risk for severe RA and pulmonary and cardiovascular disease (CVD). Despite this, little is known about smoking cessation counseling by rheumatologists. Objectives We examined predictors of tobacco counseling in RA patients who smoke including the effect of perceived RA control. We hypothesized that patients with controlled RA would receive more counseling according to the competing demands model, which explains that preventive care gaps occur as a result of competing provider, patient, and clinic factors. Methods This secondary data analysis involved RA patients with an additional CVD risk factor identified in an academic medical center 2004–2011. Trained abstractors assessed documented smoking counseling and rheumatologists’ impression of RA control in clinic notes. We used multivariable logistic regression to predict having received smoking cessation counseling, including sociodemographics and comorbidity in models. Results We abstracted 3,396 RA visits, including 360 visits (10%) with active smokers. Perceived controlled RA was present in 31% of visits involving smokers (39% in non-smokers). Beyond nurse documentation, providers documented smoking status in 39% of visit notes with smokers, and smoking cessation counseling in 10%. Visits with controlled versus active RA were less likely to include counseling (OR 0.3, CI 0.1–0.97). Counseling was more likely in visits with prevalent cardiovascular, pulmonary, and psychiatric disease, but decreased with obesity. Conclusions Smoking cessation counseling was documented in 10% of visits and was less likely when RA was controlled. Given smoking’s impact on RA and long-term outcomes, systematic cessation counseling efforts are needed.

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“…This is well illustrated in the area of cardiovascular disease (CVD) prevention, where clinic protocols executed by medical assistants have improved the proportion of primary care clinic patients whose blood pressure (BP) is controlled from 50 to > 80% [ 8 ]. In specialty clinics, however, clinicians discuss CVD risk factors such as BP or tobacco in only 10% of relevant specialty visits, despite routinely assessing them [ 9 , 10 ]. Non-vascular specialty clinics have not implemented protocols to address high BP and tobacco use, which are the most prevalent risk factors for CVD in US adults.…”

Section: Introductionmentioning

confidence: 99%

Interactive and Participatory Audit and Feedback (IPAF): theory-based development and multi-site implementation outcomes with specialty clinic staff

Ramly

Lauver

Gilmore‐Bykovskyi

et al. 2021

Implement Sci Commun

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Background Theory-based implementation strategies, such as audit and feedback (A&F), can improve the adoption of evidence-based practices. However, few strategies have been developed and tested to meet the needs of specialty clinics. In particular, frontline staff can execute cardiovascular disease (CVD) risk reduction protocols, but A&F strategies to support them are not well examined. Our objective was to develop and evaluate a theory-based approach to A&F, Interactive and Participatory A&F (IPAF). Methods We developed IPAF informed by two complementary theories, self-regulation theory (SRT) and self-determination theory (SDT). IPAF applies concepts from these theories to inform (1) what to address with staff to improve rates of best practices (SRT) and (2) how to interact with staff to improve behaviors aligned with best practices (SDT). We promoted IPAF fidelity by developing a semi-structured guide to facilitate staff discussion of target behaviors, perceived barriers, goals, and action plans. We evaluated IPAF in the context of eight quasi-experimental implementations in specialty clinics across two health systems. Following a hybrid type 2 effectiveness-implementation design, we reported intervention outcomes for CVD risk reduction elsewhere. This paper reports implementation outcomes associated with IPAF, focusing on feasibility, appropriateness, acceptability, fidelity, and adoption. We evaluated implementation outcomes using mixed-methods data including electronic health record (EHR) data, team records, and staff questionnaire responses. Results Eighteen staff participated in 99 monthly, individual, synchronous (face-to-face or phone) IPAF sessions during the first 6 months of implementation. Subsequently, we provided over 375 monthly feedback emails. Feasibility data revealed high staff attendance (90–93%) and engagement in IPAF sessions. Staff highly rated questionnaire items about IPAF acceptability. Team records and staff responses demonstrated fidelity of IPAF delivery and receipt. Adoption of target behaviors increased significantly (all P values < 0.05), and adoption or behaviors were maintained for over 24 months. Conclusions We developed and evaluated a theory-based approach to A&F with frontline staff in specialty clinics to improve the implementation of evidence-based interventions. The findings support feasibility, appropriateness, acceptability, and fidelity of IPAF, and staff adoption and maintenance of target behaviors. By evaluating multi-site implementation outcomes, we extended prior research on clinic protocols and A&F beyond primary care settings and providers.

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Frequency and Predictors of Communication About High Blood Pressure in Rheumatoid Arthritis Visits

Abstract: 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.

Cited by 10 publications

References 34 publications

Connecting Rheumatology Patients to Primary Care for High Blood Pressure: Specialty Clinic Protocol Improves Follow‐up and Population Blood Pressures

Connecting Rheumatology Patients to Primary Care for High Blood Pressure: Specialty Clinic Protocol Improves Follow‐up and Population Blood Pressures

Rheumatologists Modestly More Likely to Counsel Smokers in Visits Without Rheumatoid Arthritis Control

Interactive and Participatory Audit and Feedback (IPAF): theory-based development and multi-site implementation outcomes with specialty clinic staff

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