UBC Faculty Research and Publications

Quality of Care for Cardiovascular Disease Prevention in Rheumatoid Arthritis : Compliance with Diabetes Screening Guidelines Schmidt, Timothy Joseph; Aviña-Zubieta, J. Antonio; Sayre, E. C.; Abrahamowicz, Michal; Esdaile, John; Lacaille, Diane


Objective: To evaluate compliance with diabetes screening guidelines for cardiovascular disease prevention in Rheumatoid Arthritis (RA) compared to the general population. Methods: We conducted the first longitudinal study of a population-based RA cohort including all prevalent RA cases in British Columbia between 1996 and 2006, followed-up until 2010, with matched general population comparators. Using administrative data, we measured compliance with general population guidelines, i.e. testing plasma glucose (PG) at least once every three years after age 45, after excluding individuals with previous diabetes. Follow-up was divided into three-year eligibility periods. Compliance was measured as the proportion of periods with ≥1 PG test performed. OR (95% CI) of compliance in RA (vs. general population) was calculated using GEE models, adjusting for age and sex. Mean compliance rate per patient was also calculated and compared using Mann-Whitney U test. Results: Analysis included 22,624 individuals with RA, contributing 48,724 three-year eligibility periods; and 22,579general population, contributing 51,081 three-year eligibility periods. PG was measured in 72.3% (SD=37%) of the eligible time periods in the RA sample and in 70.4% (SD=38%) for the general population (OR=1.05 [95% CI:1.02;1.09], p<.0001). RA individuals met recommended screening guidelines in 71.4% of their eligible periods, compared to 70.6% (p<.001). Screening improved over time in RA relative to the general population. Family physicians ordered nearly all the PG tests. Conclusion: Compliance with general population guidelines for diabetes screening in RA was suboptimal, with little difference relative to the general population, despite a higher risk of cardiovascular diseases and diabetes.

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