Preventive medical services among patients with rheumatoid arthritis

To assess the degree to which patients with rheumatoid arthritis (RA) receive health maintenance and preventive care procedures recommended by the United States Preventive Services Task Force (USPSTF), a government appointed independent expert panel whose recommendations are based on a systematic review of the evidence of effectiveness of clinical preventive services.

Clinical data from 1987 to 1995 were abstracted from the complete (inpatient and outpatient) medical records of a population based sample of patients with RA (defined using the 1987 American College of Rheumatology diagnostic criteria). We assessed probability of receiving 6 preventive medical services: blood pressure testing (once every 2 years), lipids profile (once every 5 years), flu vaccination (once a year for persons over 65), pneumococcal vaccination (one time for persons over 65), as well as mammograms (biennially for ages 40-49 and annually for those 50 and over) and cervical cancer screening (once every 3 years). These probabilities were summarized using the Kaplan-Meier method. Cox proportional hazards models were used to assess the association of a number of clinical variables with time to performance of each preventive service.

A total of 67 men and 197 women, with a mean age of 64.4 years and median length of followup time of 5.4 years, were identified. In this cohort, the probability of lipids screening by 5 years was 88% and blood pressure screening by 2 years was 95%. Among the 169 patients aged > or = 65 years, the probability of a one-time pneumococcal vaccination was 38% by 5 years of followup and the probability of a yearly flu vaccination was 32%. Among 185 women without a history of breast cancer, mammograms were performed for 68% of women by the end of 2 years from ages 40 to 49 years and for 33% of women by one year beginning at age 50 years. Of the 133 women without a history of hysterectomy, the probability of Papanicolaou smears within 3 years was 77%. No consistent statistically significant association of age, sex, calendar year, total or rheumatologist visits, Charlson comorbidity index, or RA disease characteristics with performance of these preventive services was detected.

Patients with RA do not receive optimal health maintenance and preventive care services. Efforts should be made, on the part of all physicians who care for RA patients, to ensure that these effective preventive services are provided.