scholarly journals Rheumatologist and Primary Care Management of Cardiovascular Disease Risk in Rheumatoid Arthritis: Patient and Provider Perspectives

2016 ◽  
Vol 68 (4) ◽  
pp. 415-423 ◽  
Author(s):  
Christie M. Bartels ◽  
Tonya J. Roberts ◽  
Karen E. Hansen ◽  
Elizabeth A. Jacobs ◽  
Andrea Gilmore ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Rheumatoid Arthritis Patient ◽  
Care Management ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Provider Perspectives ◽  
Patient And Provider Perspectives ◽  
Primary Care Management

scholarly journals Improving coding and primary care management for patients with chronic kidney disease: an observational controlled study in East London

2019 ◽  
Vol 69 (684) ◽  
pp. e454-e461 ◽  
Author(s):  
Sally A Hull ◽  
Vian Rajabzadeh ◽  
Nicola Thomas ◽  
Sec Hoong ◽  
Gavin Dreyer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Care Management ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Controlled Study ◽  
Diagnostic Coding ◽  
Primary Care Management

BackgroundThe UK national chronic kidney disease (CKD) audit in primary care shows diagnostic coding in the electronic health record for CKD averages 70%, with wide practice variation. Coding is associated with improvements to risk factor management; CKD cases coded in primary care have lower rates of unplanned hospital admission.AimTo increase diagnostic coding of CKD (stages 3–5) and primary care management, including blood pressure to target and prescription of statins to reduce cardiovascular disease risk.Design and settingControlled, cross-sectional study in four East London clinical commissioning groups (CCGs).MethodInterventions to improve coding formed part of a larger system change to the delivery of renal services in both primary and secondary care in East London. Quarterly anonymised data on CKD coding, blood pressure values, and statin prescriptions were extracted from practice computer systems for 1-year pre- and post-initiation of the intervention.ResultsThree intervention CCGs showed significant coding improvement over a 1 year period following the intervention (regression for post-intervention trend P<0.001). The CCG with highest coding rates increased from 76–90% of CKD cases coded; the lowest coding CCG increased from 52–81%. The comparison CCG showed no change in coding rates. Combined data from all practices in the intervention CCGs showed a significant increase in the proportion of cases with blood pressure achieving target levels (difference in proportion P<0.001) over the 2-year study period. Differences in statin prescribing were not significant.ConclusionClinically important improvements to coding and management of CKD in primary care can be achieved by quality improvement interventions that use shared data to track and monitor change supported by practice-based facilitation. Alignment of clinical and CCG priorities and the provision of clinical targets, financial incentives, and educational resource were additional important elements of the intervention.

scholarly journals Electrocardiographic screening in primary care for cardiovascular disease risk and atrial fibrillation

2019 ◽  
Vol 20 ◽  
Author(s):  
Ralf E. Harskamp
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Diagnostic Testing ◽  
Routine Care ◽  
Pulse Palpation ◽  
Primary Care Patients ◽  
Ecg Abnormalities

Abstract Electrocardiograms (ECGs) are frequently recorded in primary care for screening purposes. An ECG is essential in diagnosing atrial fibrillation, and ECG abnormalities are associated with cardiovascular events. While recent studies show that ECGs adequately reclassify a proportion of patients based on the clinical risk score calculations, there are no data to support that this also results in improved health outcomes. When applied for screening for atrial fibrillation, more cases are found with routine care, but this would be undone when physicians would perform systematic pulse palpation. In most studies, the harms of routine ECG use (such as unnecessary diagnostic testing, emotional distress, increased health expenses) were poorly documented. As such, the routine performing of ECGs in asymptomatic primary care patients, whether it is for cardiovascular disease risk assessment or atrial fibrillation, cannot be recommended.

scholarly journals Accelerated aging influences cardiovascular disease risk in rheumatoid arthritis

2013 ◽  
pp. n/a-n/a ◽  
Author(s):  
Cynthia S. Crowson ◽  
Terry M. Therneau ◽  
John M. Davis ◽  
Véronique L. Roger ◽  
Eric L. Matteson ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Accelerated Aging
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