Delay in consultation with specialists for persons with suspected new-onset rheumatoid arthritis:: A population-based study
Delay in consultation with specialists for persons with suspected new-onset rheumatoid arthritis:: A population-based study
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DOI：
10.1002/art.23086
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发表时间：
2007-12-15
期刊：
影响因子：
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通讯作者：
Abrahamowicz, Michal
中科院分区：
文献类型：
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作者：
Feldman, Debbie Ehrmann;Bernatsky, Sasha;Abrahamowicz, Michal
目标。类风湿关节炎（RA）的护理是由风湿病学家的参与优化。我们希望确定魁北克怀疑新发RA的患者是否咨询了风湿病学家，记录这些咨询的任何延误，并确定与及时咨询相关的因素。获得了魁北克省所有成年人的医生报销管理数据。2000年疑似新发类风湿性关节炎病例被定义为因类风湿性关节炎就诊的医生（根据《国际疾病分类》第九版诊断代码），而在此前3年没有因类风湿性关节炎就诊过任何医生。对于那些最初由非风湿病学家诊断的患者，使用Cox回归模型来确定与风湿病学家咨询时间相关的患者和医生特征。在1001名被非风湿病学家编码为偶发类风湿性关节炎的患者中，只有27.3%的患者在接下来的2.5-3.5年内咨询了风湿病学家。在那些进行咨询的患者中，从首次因类风湿性关节炎就诊到咨询风湿病专家的中位时间为79天。咨询时间较短的最强预测因子是女性、年龄较小、社会经济地位较高、合并症较多。我们的数据表明，绝大多数怀疑患有新发RA的患者没有接受风湿病治疗。进一步的行动应该集中在这个问题上，这样RA的结果可能会得到优化。
Objective. Care in rheumatoid arthritis (RA) is optimized by involvement of rheumatologists. We wished to determine whether patients suspected of having new-onset RA in Quebec consulted with a rheumatologist, to document any delay in these consultations, and to determine factors associated with prompt consultation.Methods. Physician reimbursement administrative data were obtained for all adults in Quebec. Suspected new-onset cases of RA in the year 2000 were defined operationally as a physician visit for RA (based on the International Classification of Diseases, Ninth Revision diagnostic codes), where there had been no prior visit code to any physician for RA in the preceding 3 years. For those patients who were first diagnosed by a nonrheumatologist, Cox regression modeling was used to identify patient and physician characteristics associated with time to consultation with a rheumatologist.Results. Of the 10,001 persons coded as incident RA by a nonrhemnatologist, only 27.3% consulted a rheumatologist within the next 2.5-3.5 years. Of those who consulted, the median time from initial visit to a physician for RA to consultation with a rheumatologist was 79 days. The strongest predictors of shorter time to consultation were female sex, younger age, being in a higher socioeconomic class, and having greater comorbidity.Conclusion. Our data suggest that the vast majority of patients suspected of having new-onset RA do not receive rheumatology care. Further action should focus on this issue so that outcomes in RA may be optimized.