Primary care physicians (PCP), which includes general internists and family medicine doctors, typically manage and coordinate most of the health care a patient receives.1,2 They are usually the first point-of-contact for questions, new problems, and injuries. They also perform wellness check-ups and critical screening, such as for cancer and risk factors for heart attack and stroke.3 Screening can result in early identification of cancers allowing for early and optimized treatments. PCPs provide lifestyle counseling for preventable conditions such as hypertension, hyperlipidemia, and type 2 diabetes.2 They are the first-line of treatment for all of these types of conditions with the goal to prevent disease progression and morbidity. Often, they are also the first to identify and diagnose other serious chronic conditions, such as rheumatoid arthritis (RA) or lupus. PCPs assess all of a patient’s medical problems and refer and defer to specialists, when needed, for the treatment of complex or chronic conditions.
Patients with rheumatological diseases usually require a specialist called a rheumatologist who has special training to manage their disease.4 In the best case, a patient’s PCP and rheumatologist communicate and work together to provide streamlined and comprehensive care.
Studies have shown that patients with RA who also see their PCP regularly are more likely to receive critical disease screening than those who do not see their PCP. For example, a 2018 study5 examined US claims data from 2006 to 2010 and identified patients with RA (n=12,182), diabetes mellitus (DM) (n=62,834), both RA and DM (n=1,082), or neither condition (n=167,811). After analyzing the number of patients screened for hyperlipidemia, the authors found that patients who saw both a rheumatologist as well as a non-rheumatologist clinician during follow-up had a 55% (95% confidence interval [CI] [1.36 – 1.78]) higher probability of having hyperlipidemia screening than those who only saw a rheumatologist. Bartels et al. also examined lipid screening in 3298 patients with RA.6 They found that screening was decreased by 22% (adjusted risk ratio 0.78, 95% CI [0.71 – 0.84]) in patients who did not see a PCP at least annually.
References
- U.S. National Library of Medicine. Choosing a primary care provider. 2017; https://medlineplus.gov/ency/article/001939.htm. Accessed June 7, 2019.
- Shi L. The impact of primary care: a focused review. Scientifica (Cairo) 2012; 2012: 432892.
- Curry SJ, Krist AH, Owens DK. Eighth Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services. U.S. Preventive Services Task Force; Nov 2018.
- Rat AC, Henegariu V, Boissier MC. Do primary care physicians have a place in the management of rheumatoid arthritis? Joint Bone Spine 2004; 71 (3): 190-197.
- Navarro-Millan I, Yang S, Chen L, et al. Screening of hyperlipidemia among patients with rheumatoid arthritis in the United States. Arthritis Care Res (Hoboken) 2018.
- Bartels CM, Kind AJ, Everett C, Mell M, McBride P, Smith M. Low frequency of primary lipid screening among medicare patients with rheumatoid arthritis. Arthritis Rheum 2011; 63 (5): 1221-1230.
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