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  1. I. Sheriff1,
  2. A. Lima2,
  3. O. Tseng3,
  4. A. Aviña2,4,
  5. M. Dawes5,
  6. C. E. H. Barber6,
  7. J. Esdaile2,7,
  8. K. Shojania2,7,
  9. C. L. Koehn8,
  10. A. Hoens2,9,
  11. S. Mcquitty10,
  12. S. Singh5,
  13. J. Yap3,11,
  14. D. Page12,
  15. J. Kur7,
  16. B. Hobson3,13,
  17. M. Price3,
  18. D. Lacaille2,7
  1. 1Arthritis Research Canada, Summer Student Research, Vancouver, Canada
  2. 2Arthritis Research Canada, Research, Vancouver, Canada
  3. 3The University of British Columbia, Department of Family Practice, Vancouver, Canada
  4. 4The University of British Columbia, Department of Medicine, Division of Rheumatology, Vancouver, Canada
  5. 3The University of British Columbia, Department of Family Practice, Vancouver, Canada
  6. 6University of Calgary, Departments of Medicine and Community Health Sciences, Calgary, Canada
  7. 4The University of British Columbia, Department of Medicine, Division of Rheumatology, Vancouver, Canada
  8. 8Arthritis Consumer Experts, President, Vancouver, Canada
  9. 9The University of British Columbia, Department of Physical Therapy, Vancouver, Canada
  10. 10Arthritis Research Canada, Arthritis Patient Advisory Board, Vancouver, Canada
  11. 11New Westminster Family Practice, Family Physician, New Westminster, Canada
  12. 12The University of British Columbia, UBC Family Practice Residency Program, Vancouver, Canada
  13. 13Doctors of BC (previously BC Medical Association) Shared Care Committee and Practice Support Program for Family Physicians, Family Physician, Vancouver, Canada


Background: Inflammatory arthritis (IA) predisposes patients to several chronic conditions including cardiovascular diseases (CVD), diabetes (DM), osteoporosis (OP) and infections, likely due to systemic effects of inflammation. Studies have found that patients with IA often receive suboptimal care for screening and managing these conditions.

Objectives: This is the first phase of a study which will develop and pilot test automated EMR reminders for family physicians. The reminders will prompt family physicians to screen for and address risk factors for these conditions. We conducted a Delphi process to select care recommendations to be addressed by the EMR reminders.

Methods: We conducted a review of current BC, Canadian and international guidelines for screening and addressing risk factors for CVD, DM, OP and infection. A list of 22 care recommendations, including their level of evidence and risks/benefits of implementation, was reviewed by a panel of six family physicians, three rheumatologists and three IA patients, in a three-round online modified Delphi process. Panelists rated each care recommendation, using 9-point scales, on 1) their clinical importance, 2) their likelihood of improving outcomes, and 3) implementation feasibility. Results were discussed in an online forum. Panelists then rated slightly revised care recommendations, modified based on feedback from the discussion. Care recommendations were retained if the median rating was ≥7 with no disagreement as defined by the RAND/UCLA Method handbook.

Results: A list of 15 care recommendations was selected by the Delphi process for EMR integration, including recommendations that address CVD risk assessment (1), hypertension screening (1), DM screening (2), fracture risk assessment (1), BMD testing (1), osteoporosis prevention (1) and treatment (1) with bisphosphonates, preventing infections through immunization (2), minimizing steroids (1) and hepatitis screening (1), screening for hydroxychloroquine retinal toxicity (1), and counselling for lifestyle modifications (2). We excluded 7 recommendations which addressed lipid testing (1), BMD testing in steroid users (1), immunizations (2), weight management (1), and DMARD laboratory test monitoring (2). Recommendations were excluded on the basis of importance (1) or feasibility (6).

Conclusion: The results of the Delphi process will inform the development of reminders, integrated in EMRs, that will support family physicians in their efforts to engage IA patients in addressing risk factors for chronic diseases related to inflammation. We hope to improve the prevention of these diseases, which represent an important cause of morbidity and mortality for people with inflammatory arthritis.

Acknowledgements: Iman Sheriff’s work on this project was funded by the CRA summer studentship programme. Dr. Lacaille is supported by the Mary Pack Chair in Arthritis Research from UBC and The Arthritis Society of Canada. Thank you to all who participated in the Delphi survey.

Disclosure of Interests: None declared

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