Mariano Andrés1, Francisca Sivera2, Sabina Pérez-Vicente3, Paloma Vela4,5, Loreto Carmona6. 1. Sección de Reumatología, Hospital General Universitario de Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain. drmarianoandres@gmail.com. 2. Sección de Reumatología, Hospital General Universitario de Elda, Alicante, Spain. 3. Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain. 4. Sección de Reumatología, Hospital General Universitario de Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain. 5. Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain. 6. Instituto de Salud Musculoesquelética (inMusc), Madrid, Spain.
Abstract
OBJECTIVE: To describe the variability in rheumatology visits and referrals to other medical specialties of patients with spondyloarthritis (SpA) and to explore factors that may influence such variability. METHODS: Nation-wide cross-sectional study performed in 2009-2010. Randomly selected records of patients with a diagnosis of SpA and at least one visit to a rheumatology unit within the previous 2 years were audited. The rates of rheumatology visits and of referrals to other medical specialties were estimated-total and between centres-in the study period. Multilevel regression was used to analyse factors associated with variability and to adjust for clinical and patient characteristics. RESULTS: 1168 patients' records (45 centres) were reviewed, mainly ankylosing spondylitis (55.2 %) and psoriatic arthritis (22.2 %). The patients had incurred in 5908 visits to rheumatology clinics (rate 254 per 100 patient-years), 4307 visits to other medical specialties (19.6 % were referrals from rheumatology), and 775 visits to specialised nurse clinics. An adjusted variability in frequenting rheumatology clinics of 15.7 % between centres was observed. This was partially explained by the number of faculties and trainees. The adjusted intercentre variability for referrals to other specialties was 12.3 %, and it was associated with urban settings, number of procedures, and existence of SpA dedicated clinics; the probability of a patient with SpA of being referred to other specialist may increase up to 25 % depending on the treating centre. CONCLUSION: Frequenting rheumatology clinics and referrals to other specialists significantly varies between centres, after adjustment by patient characteristics.
OBJECTIVE: To describe the variability in rheumatology visits and referrals to other medical specialties of patients with spondyloarthritis (SpA) and to explore factors that may influence such variability. METHODS: Nation-wide cross-sectional study performed in 2009-2010. Randomly selected records of patients with a diagnosis of SpA and at least one visit to a rheumatology unit within the previous 2 years were audited. The rates of rheumatology visits and of referrals to other medical specialties were estimated-total and between centres-in the study period. Multilevel regression was used to analyse factors associated with variability and to adjust for clinical and patient characteristics. RESULTS: 1168 patients' records (45 centres) were reviewed, mainly ankylosing spondylitis (55.2 %) and psoriatic arthritis (22.2 %). The patients had incurred in 5908 visits to rheumatology clinics (rate 254 per 100 patient-years), 4307 visits to other medical specialties (19.6 % were referrals from rheumatology), and 775 visits to specialised nurse clinics. An adjusted variability in frequenting rheumatology clinics of 15.7 % between centres was observed. This was partially explained by the number of faculties and trainees. The adjusted intercentre variability for referrals to other specialties was 12.3 %, and it was associated with urban settings, number of procedures, and existence of SpA dedicated clinics; the probability of a patient with SpA of being referred to other specialist may increase up to 25 % depending on the treating centre. CONCLUSION: Frequenting rheumatology clinics and referrals to other specialists significantly varies between centres, after adjustment by patient characteristics.
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