From the Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY.
School of Nursing, University of Wisconsin-Madison.
J Clin Rheumatol. 2022 Oct 1;28(7):354-361. doi: 10.1097/RHU.0000000000001868. Epub 2022 Jun 12.
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.
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.
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.
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.
由于炎症和传统风险因素（如高血压[BP]和吸烟），患有风湿性疾病的患者患心血管疾病（CVD）的风险增加。然而，风湿科诊所很少解决传统的危险因素，尽管它们在初级保健中是常规评估和可改变的。本研究旨在：（1）描述风湿科诊所工作人员解决高血压和吸烟问题的工作流程；（2）确定有效管理这些危险因素的障碍和策略。
我们在 2 个卫生系统的 4 个成人风湿科诊所对医疗助理、护士和调度人员进行了 7 次焦点小组讨论（BP 焦点小组，n = 23；吸烟焦点小组，n = 20）。使用主题分析对转录本进行分析，以阐明障碍和策略。
我们发现了管理高血压和吸烟风险的 3 个诊所工作流程：（1）风险识别；（2）在诊所内进行随访；（3）与初级保健和社区资源进行随访。在这些流程中，我们确定了分为以下主题的障碍和策略：（1）时间；（2）诊所工作流程；（3）技术和资源；（4）员工的态度和知识；（5）员工对患者的看法。最普遍的障碍是：（1）没有用于随访的结构化系统；（2）员工在发起有关健康相关行为改变的对话方面的信心和技能不足。
我们的研究确定了风湿科工作人员在患者中解决高血压和吸烟问题的工作流程和能力方面存在的普遍差距。未来支持员工需求的努力应针对：（1）诊所内外的随访系统；（2）对话支持工具。
