Michelle Tong1, Andrea Gilmore-Bykovskyi, Laura Block2, Edmond Ramly, Douglas W White3, Monica L Messina4, Christie M Bartels4. 1. From the Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY. 2. School of Nursing, University of Wisconsin-Madison. 3. Rheumatology, Gundersen Health System, Onalaska. 4. Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Abstract
OBJECTIVE: Patients with rheumatologic conditions are at elevated risk of cardiovascular disease (CVD) due to inflammatory and traditional risk factors, such as high blood pressure (BP) and smoking. However, rheumatology clinics rarely address traditional risk factors, although they are routinely assessed and modifiable in primary care. The present study sought to (1) characterize rheumatology clinic staff's work process for addressing high BP and smoking and (2) identify barriers and strategies for effective management of these risk factors. METHODS: We conducted 7 focus groups with medical assistants, nurses, and scheduling staff from 4 adult rheumatology clinics across 2 health systems (BP focus groups, n = 23; smoking, n = 20). Transcripts were analyzed using thematic analysis to elucidate barriers and strategies. RESULTS: We found 3 clinic work processes for the management of high BP and smoking risk: (1) risk identification, (2) follow-up within the clinic, and (3) follow-up with primary care and community resources. Within these processes, we identified barriers and strategies grouped into themes: (1) time, (2) clinic workflows, (3) technology and resources, (4) staff's attitudes and knowledge, and (5) staff's perceptions of patients. The most pervasive barriers were (1) no structured system for follow-up and (2) staff confidence and skill in initiating conversations about health-related behavior change. CONCLUSIONS: Our study identified generalizable gaps in rheumatology staff's work processes and competencies for addressing high BP and smoking in patients. Future efforts to support staff needs should target (1) systems for follow-up within and outside the clinic and (2) conversation support tools.
OBJECTIVE: Patients with rheumatologic conditions are at elevated risk of cardiovascular disease (CVD) due to inflammatory and traditional risk factors, such as high blood pressure (BP) and smoking. However, rheumatology clinics rarely address traditional risk factors, although they are routinely assessed and modifiable in primary care. The present study sought to (1) characterize rheumatology clinic staff's work process for addressing high BP and smoking and (2) identify barriers and strategies for effective management of these risk factors. METHODS: We conducted 7 focus groups with medical assistants, nurses, and scheduling staff from 4 adult rheumatology clinics across 2 health systems (BP focus groups, n = 23; smoking, n = 20). Transcripts were analyzed using thematic analysis to elucidate barriers and strategies. RESULTS: We found 3 clinic work processes for the management of high BP and smoking risk: (1) risk identification, (2) follow-up within the clinic, and (3) follow-up with primary care and community resources. Within these processes, we identified barriers and strategies grouped into themes: (1) time, (2) clinic workflows, (3) technology and resources, (4) staff's attitudes and knowledge, and (5) staff's perceptions of patients. The most pervasive barriers were (1) no structured system for follow-up and (2) staff confidence and skill in initiating conversations about health-related behavior change. CONCLUSIONS: Our study identified generalizable gaps in rheumatology staff's work processes and competencies for addressing high BP and smoking in patients. Future efforts to support staff needs should target (1) systems for follow-up within and outside the clinic and (2) conversation support tools.
Authors: Aimée Wattiaux; Brittany Bettendorf; Laura Block; Andrea Gilmore-Bykovskyi; Edmond Ramly; Megan E Piper; Ann Rosenthal; Jane Sadusky; Elizabeth Cox; Betty Chewning; Christie M Bartels Journal: Arthritis Care Res (Hoboken) Date: 2020-03 Impact factor: 4.794
Authors: R Agca; S C Heslinga; S Rollefstad; M Heslinga; I B McInnes; M J L Peters; T K Kvien; M Dougados; H Radner; F Atzeni; J Primdahl; A Södergren; S Wallberg Jonsson; J van Rompay; C Zabalan; T R Pedersen; L Jacobsson; K de Vlam; M A Gonzalez-Gay; A G Semb; G D Kitas; Y M Smulders; Z Szekanecz; N Sattar; D P M Symmons; M T Nurmohamed Journal: Ann Rheum Dis Date: 2016-10-03 Impact factor: 19.103
Authors: Pip Aimer; Gareth J Treharne; Simon Stebbings; Chris Frampton; Vicky Cameron; Sandra Kirby; Lisa K Stamp Journal: Arthritis Care Res (Hoboken) Date: 2016-11-16 Impact factor: 4.794
Authors: Ernest Choy; Kandeepan Ganeshalingam; Anne Grete Semb; Zoltán Szekanecz; Michael Nurmohamed Journal: Rheumatology (Oxford) Date: 2014-06-06 Impact factor: 7.580