Despite high risk for cardiovascular disease (CVD) mortality, screening and treatment of hyperlipidemia in patients with rheumatoid arthritis (RA) is suboptimal. We asked primary care physicians (PCPs) and rheumatologists to identify barriers to screening and treatment for hyperlipidemia among patients with RA. We recruited rheumatologists and PCPs nationally to participate in separate moderated structured group teleconference discussions using the nominal group technique. Participants in each group generated lists of barriers to screening and treatment for hyperlipidemia in patients with RA, then each selected the three most important barriers from this list. The resulting barriers were organized into physician-, patient- and system-level barriers, informed by the socioecological framework. Twenty-seven rheumatologists participated in a total of 3 groups (group size ranged from 7 to 11) and twenty PCPs participated in a total of 3 groups (group size ranged from 4 to 9). Rheumatologists prioritized physician level barriers (e.g. ‘ownership’ of hyperlipidemia screening and treatment), whereas PCPs prioritized patient-level barriers (e.g. complexity of RA and its treatments). Rheumatologists were conflicted about whether treatment of CVD risk among patients with RA should fall within the role of the rheumatologist or the PCP. All participating PCPs agreed that CVD risk reduction was within their role. Factors that influenced PCPs’ decisions for screening and treatment for CVD risk in patients with RA were mainly related to their concern about how treatment for CVD risk could influence RA symptomatology (myalgia from statins) or how inflammation from RA and RA medications influences lipid profiles.

中文翻译：

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初级保健医师和风湿病学家对类风湿关节炎患者高脂血症筛查和治疗的看法

尽管心血管疾病 (CVD) 死亡率高，但对类风湿性关节炎 (RA) 患者的高脂血症的筛查和治疗并不理想。我们要求初级保健医师 (PCP) 和风湿病学家确定 RA 患者筛查和治疗高脂血症的障碍。我们在全国范围内招募风湿病学家和 PCP 使用名义小组技术参加单独的有主持的结构化小组电话会议讨论。每组的参与者生成了 RA 患者高脂血症筛查和治疗障碍的列表，然后每个人从该列表中选择三个最重要的障碍。由此产生的障碍被组织成医生、患者和系统层面的障碍，由社会生态框架提供信息。27 名风湿病学家参加了总共 3 个小组（小组规模从 7 到 11 人不等），20 名 PCP 参加了总共 3 个小组（小组规模从 4 到 9 人不等）。风湿病学家优先考虑医师层面的障碍（例如高脂血症筛查和治疗的“所有权”），而 PCP 优先考虑患者层面的障碍（例如 RA 及其治疗的复杂性）。风湿病学家对于 RA 患者 CVD 风险的治疗是否应属于风湿病学家或 PCP 的角色存在争议。所有参与的 PCP 都同意降低 CVD 风险在他们的职责范围内。