Primary care screening and comorbidity management in rheumatoid arthritis in Ontario, Canada

Objective — 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.

Methods — 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 on age and sex. Stratified analyses were performed, comparing patients with versus without RA, to assess the performance of quality measures.

Results — We compared 1,405 RA patients to 14,050 matched non-RA patients (72.8% female with a mean age of 62.5 years). RA patients more frequently had influenza (44.9% vs. 40.0%) and pneumococcal (40.4% vs. 34.1%) vaccinations, and bone mineral density testing (67.4% vs. 58.1%) in comparison to non-RA patients, respectively. Zoster vaccinations were less frequent among RA patients (13.8% vs. 19.5%), as well as screening for cervical cancer (58.6% vs. 64.0%). No significant differences were observed for breast (70.7% vs. 73.8%) and colorectal cancer (31.7% vs. 34.5%) screenings. Only a quarter of RA patients had a comprehensive cardiovascular risk assessment. No definite differences were detected in the management of patients who had co-occurring cardiovascular diseases or diabetes.

Conclusion — In both RA and non-RA patients, there was low performance with Canadian recommendations for preventative medical services and screening for comorbid conditions in primary care. This suggests key targets for improvement.