Ward M M
Veterans Affairs Palo Alto Health Care System, Department of Medicine, Stanford University School of Medicine, Palo Alto, California 94304, USA.
Curr Opin Rheumatol. 2000 Mar;12(2):99-103. doi: 10.1097/00002281-200003000-00003.
Studies of the costs associated with rheumatic diseases, the referral of patients to rheumatology subspecialty care, rheumatology practice patterns, and the relation between medical care and patient outcomes are reviewed. Direct medical costs in patients with rheumatoid arthritis (RA) are higher among those with more functional disability. Direct medical costs in patients with systemic lupus erythematosus (SLE) did not differ among Canadian, American, and British patients, despite substantial differences in the mechanisms by which medical care is financed and delivered in these three countries. The diagnostic accuracy of rheumatic complaints by primary care physicians may be low, and concomitant psychiatric disorders may not be uncommon among patients referred to rheumatologists. Most patient visits to rheumatologists involve patients with rheumatic diseases or musculoskeletal complaints, and few visits involve primary care. Fewer than half of elderly patients with RA or SLE are seen by a rheumatologist in a given year; access is particularly limited among black women. Early access to rheumatology subspecialty care may be associated with improved health status in patients with RA, and mortality among patients with SLE varies with the experience a hospital has in treating patients with SLE.
本文综述了与风湿性疾病相关的成本、患者转诊至风湿科专科护理的情况、风湿科的诊疗模式以及医疗护理与患者预后之间的关系。类风湿关节炎（RA）患者中，功能残疾程度越高，直接医疗成本越高。尽管加拿大、美国和英国在医疗护理的筹资和提供机制上存在显著差异，但系统性红斑狼疮（SLE）患者的直接医疗成本在这三个国家的患者中并无差异。初级保健医生对风湿性疾病主诉的诊断准确性可能较低，转诊至风湿科医生的患者中，并发精神障碍的情况可能并不少见。大多数患者就诊于风湿科医生时患有风湿性疾病或有肌肉骨骼方面的主诉，很少有患者是由初级保健转诊而来。在特定年份中，不到一半的老年RA或SLE患者会看风湿科医生；黑人女性获得专科护理的机会尤其有限。早期获得风湿科专科护理可能与RA患者健康状况改善有关，SLE患者的死亡率因医院治疗SLE患者的经验而异。
