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Barriers and facilitators for screening and treatment of hyperlipidemia among patients with inflammatory arthritis
Iris Navarro-Millán1,2, Sarah R Young3, Sally Shurbaji4
1Weill Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, 420 East 70yth Street - LH -363, New York, NY 10021 USA.
Insights
Patients with inflammatory arthritis need more education on how their condition increases cardiovascular disease (CVD) risk. Peer coaches may help overcome barriers to hyperlipidemia screening and treatment.
Area of Science:
- Rheumatology
- Cardiology
- Health Psychology
Background:
- Patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA) and psoriatic arthritis (PsA), face elevated cardiovascular disease (CVD) risk.
- Screening and treatment for hyperlipidemia, a key CVD risk factor, are notably infrequent in this patient group.
- The underlying reasons for these low rates of hyperlipidemia management in IA patients remain unclear.
Purpose of the Study:
- To identify barriers and facilitators influencing hyperlipidemia screening and treatment from the perspective of patients with IA.
- To understand patient-centered factors affecting cardiovascular risk management in inflammatory arthritis.
Main Methods:
- A qualitative study design utilizing focus groups.
- Participants included patients aged 40 and older diagnosed with IA, recruited from an academic medical center.
- Thematic analysis was employed to interpret the collected data, guided by Social Cognitive Theory.
Main Results:
- Four primary barriers were identified: insufficient information on IA and its link to CVD, lack of awareness regarding IA's impact on CVD risk, preference for lifestyle changes over medication for CVD risk reduction, and suboptimal doctor-patient communication.
- A significant facilitator emerged: the potential role of peer coaches in enhancing hyperlipidemia screening and treatment adherence.
- Participants expressed a need for better understanding of IA, its associated CVD risks, and improved communication with healthcare providers.
Conclusions:
- Patients with IA require enhanced education regarding their condition, its connection to increased CVD risk, and the importance of hyperlipidemia screening and treatment.
- Improved doctor-patient communication is crucial for addressing hyperlipidemia in IA patients.
- Patients showed openness to engaging with peer coaches to improve management of hyperlipidemia and reduce CVD risk.
Background:
Patients with inflammatory arthritis (IA), defined as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), are at increased risk for cardiovascular disease (CVD). The frequency of screening and treatment of hyperlipidemia, a modifiable CVD risk factor, is low in these patients. The reasons for low screening and treatment rates in this population are poorly understood. Our objective was to elicit the barriers and facilitators for screening and treatment of hyperlipidemia from the perspective of patients with IA.
Methods:
We conducted a qualitative study using focus groups of patients with IA, guided by Bandura's Social Cognitive Theory. We recruited patients with IA aged 40 years and older from a single academic center. Data were analyzed thematically.
Results:
We conducted three focus groups with 17 participants whose mean age was 56 (range 45-81) years; 15 were women. Four themes emerged as barriers: 1) need for more information about arthritis, prognosis, and IA medications prior to discussing additional topics like CVD risk; 2) lack of knowledge about how IA increases CVD risk; 3) lifestyle changes to reduce overall CVD risk rather than medications; and 4) the need to improve doctor-patient communication about IA, medications, and CVD risk. One theme emerged as a facilitator: 5) potential for peer coaches (patients with IA who are trained about concepts of CVD risk and IA) to help overcome barriers to screening and treatment of hyperlipidemia to lower CVD risk.
Conclusion:
Patients with IA identified educational needs about IA, increased CVD risk in IA and the need for improved doctor-patient communication about screening for hyperlipidemia and its treatment. Patients were receptive to working with peer coaches to facilitate achievement of these goals.
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