Hoekstra Monique, de Vries Harriet, van den Bosch-Schreuder Clarinda, Edens Mireille
Rheumatology, Isala, Zwolle, The Netherlands
Rheumatology, Isala, Zwolle, The Netherlands.
BMJ Open Qual. 2025 May 22;14(2):e003018. doi: 10.1136/bmjoq-2024-003018.
Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that is associated with an increased cardiovascular (CV) risk.Additional CV risk screening is advised in several national and international guidelines, but is performed inadequately. The CV risk screening in the Netherlands is performed by the general practitioner (GP).
The aim of our project was to increase the CV risk screening of patients with RA, performed by the GP, from 46% to 65% of the selected patients of 40 years and older, within the time frame of our project (18 months).
The project was carried out at the outpatient rheumatology clinic at Isala Zwolle, a large teaching hospital, in an area with 106 GP practices. Patients with RA, aged 40 years and older, who did not already participate in a cardiovascular risk management (CVRM) programme in general practice were included.
A multicomponent improvement strategy was developed and implemented. A prospective cohort follow-up study was performed, with measurements at T=0, 6, 12, 14, 16 and 18 months. The multicomponent strategy included patient education, a standard CVRM text in the electronic patient record (EPR) as a reminder, an educational meeting about CVRM in general practice for the rheumatologists and nurses, as well as feedback sessions with the rheumatologists, showing current data.
In our project, 784 RA patients were included. At time T=0, a CV risk analysis had been performed in the past 5 years in 46.4% of the patients with RA, who were not already participating in a CVRM protocol.This was significantly increased to 55.4% at 18 months in a prospective observational follow-up study. The primary goal, however, was not reached within the time frame of our project.
The availability of patient education cards and the feedback sessions with rheumatologists significantly contributed to the improvement. The implementation of an automatic standard text in the EPR, serving as an electronic reminder, did not perform as well as was anticipated.
类风湿关节炎（RA）是一种慢性炎症性关节疾病，与心血管（CV）风险增加相关。多项国家和国际指南建议进行额外的心血管风险筛查，但实际执行情况不佳。荷兰的心血管风险筛查由全科医生（GP）进行。
我们项目的目标是在项目时间框架（18个月）内，将全科医生对40岁及以上类风湿关节炎患者的心血管风险筛查比例从46%提高到65%。
该项目在伊萨拉兹沃勒的大型教学医院门诊风湿科进行，该地区有106家全科医生诊所。纳入了年龄在40岁及以上、尚未参加全科医疗心血管风险管理（CVRM）项目的类风湿关节炎患者。
制定并实施了多组分改进策略。进行了一项前瞻性队列随访研究，在T = 0、6、12、14、16和18个月时进行测量。多组分策略包括患者教育、电子病历（EPR）中的标准CVRM文本作为提醒、为风湿科医生和护士举办的关于全科医疗中CVRM的教育会议，以及与风湿科医生的反馈会议，展示当前数据。
我们的项目纳入了784例类风湿关节炎患者。在T = 0时，46.4%未参加CVRM方案的类风湿关节炎患者在过去5年中进行了心血管风险分析。在前瞻性观察随访研究中，18个月时这一比例显著提高到55.4%。然而，在我们项目的时间框架内未达到主要目标。
患者教育卡片的提供以及与风湿科医生的反馈会议对改善情况有显著贡献。在电子病历中实施自动标准文本作为电子提醒的效果不如预期。
