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Comorbidity Clinic Detects 1/3 of Patients with a Chronic Disease

November 10 2015 8:29 PM ET — via RheumReports RheumReports

EULAR recently proposed a co-morbidity screening questionnaire for patients with inflammatory arthritis. Yet finding time in a busy rheumatology practice to implement a comprehensive screening program remains a challenge.

While cost and time continue to be a barrier, a rheumatology practice in France directed by Dr. Claire Daien enrolled 184 patients (RA: 150, SpA: 29, other: 5) in a comprehensive screening program to determine the impact of this type of strategy in an outpatient clinic. She secured funding through the hospital and public health. The health care team was comprised of physicians, a nurse, a pharmacist, an occupational therapist and a physiotherapist. 

Each patient enrolled spent a full day in the clinic. The following assessments were conducted: complete medical history and physical exam, BMD, BMI, waist circumference, electrocardiogram, echocardiogram, blood pressure, lipid profile, blood glucose, Doppler sonography of the carotid, mSCORE or Framingham questionnaire, level 1 spirometry, lung assessment questionnaires (EPWORTH, IPAG, BERLIN) and prevention screening (vaccination assessment, cancer screening and dental follow-up).

At the conclusion of the day, the rheumatologist discussed the results with the patient and provided them with a written assessment. Recommendations were given to the family doctor for therapeutic interventions and follow-up in the areas of cardiovascular, lung and preventative screening measures, including vaccination. Therapeutic changes were made on-site in the areas of bone health, and advice for rehabilitation and equipment were provided during the day by the physio/occupational therapists. Follow-up was conducted at 3 months to confirm that patients had completed their intended referrals.

Here's what the comprehensive screening program found: A previously undetected chronic disease was identified in one third of patients, chronic respiratory diseases were detected in 26%, 27% were referred to a cardiologist with 21% being treated for dyslipidemia and 8% showing echocardiograph abnormalities, and hypertension was detected in 8% of patients. An osteoporotic medication was initiated in 11% of patients and physio/occupational therapy interventions were implemented in 71%. At the 3-month follow-up, 50-75% of the recommendations proposed were applied.

Based on the screening recommendations set out by EULAR and the success of this program in France, it behooves us to be creative in our own practices in implementing co-morbidity questionnaires while people wait in the exam room and to have a strong referral network within our community for assessment and screening.

If you have questions please email the author of the study: cidaien@gmail.com


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About the Author

Carolyn Whiskin
Carolyn Whiskin

Carolyn Whiskin, BSc. Phm is currently the director of pharmacy programs for the Charlton Centre for Specialized Treatments in Hamilton, Ontario. She also practices pharmacy at Brant Arts Dispensary in Burlington, Ontario and is the pharmacist representative to the Ontario Rheumatology Association’s Model of Care committee.

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