Department of Rheumatology, Pitié-Salpétriêre Hospital, 83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France.
Rheumatology (Oxford). 2010 Jan;49(1):147-55. doi: 10.1093/rheumatology/kep340. Epub 2009 Nov 23.
To assess the time to access a rheumatologist (TTAR) by early arthritis (EA) patients participating in a nationwide incidental cohort (ESPOIR) and compare it with European League Against Rheumatism (EULAR) recommendations, which recommends rapid referral, ideally within 6 weeks, to a rheumatologist for patients presenting with EA.
Eight hundred and thirteen patients with EA were included in the cohort between 2002 and 2005. The inclusion criteria were 18-70 years old, two or more swollen joints, symptom duration from 6 weeks to 6 months and possible RA diagnosis. TTAR was defined as the time between the first synovitis and first visit to a rheumatologist. TTAR and satisfaction of the EULAR guidelines were investigated by multiple linear and logistic regressions.
Mean TTAR was 76 days; only 46.2% of patients were seen by a rheumatologist within the EULAR-recommended time frame. Patients' patterns of accessing medical care substantially affected access to specialized care: mean TTAR was 58 days for patients who directly scheduled an appointment with the rheumatologist and 78 days for those referred by their general practitioner (P < 0.0007). Only 57.2 and 44.5%, respectively, were able to consult a rheumatologist within 6 weeks. Multivariate analysis confirmed the significant impact of indirect access on TTAR, after adjustment for EA characteristics and medical density in the region.
Significant disparities were identified in the care of EA patients in terms of early access to a rheumatologist. More effort is needed to optimize the physicians' knowledge about EA and to improve the efficiency of medical networks.
评估参与全国偶发性队列研究（ESPOIR）的早期关节炎（EA）患者获得风湿病学家（TTAR）的时间，并与欧洲抗风湿病联盟（EULAR）的建议进行比较，EULAR 建议对出现 EA 的患者应尽快（理想情况下在 6 周内）转诊至风湿病学家。
2002 年至 2005 年期间，该队列纳入了 813 名 EA 患者。纳入标准为年龄 18-70 岁、有两个或更多关节肿胀、症状持续时间为 6 周至 6 个月且可能患有 RA。TTAR 定义为首次关节炎发作与首次就诊风湿病学家之间的时间。通过多元线性和逻辑回归分析 TTAR 和 EULAR 指南的满意度。
平均 TTAR 为 76 天；只有 46.2%的患者在 EULAR 推荐的时间范围内就诊于风湿病学家。患者获得医疗服务的模式对获得专科医疗服务有很大影响：直接预约风湿病学家的患者平均 TTAR 为 58 天，而由全科医生转诊的患者 TTAR 为 78 天（P<0.0007）。分别只有 57.2%和 44.5%的患者能够在 6 周内咨询风湿病学家。多变量分析证实，在调整 EA 特征和该地区的医疗密度后，间接就诊对 TTAR 有显著影响。
在早期获得风湿病学家的治疗方面，EA 患者的护理存在显著差异。需要更加努力提高医生对 EA 的认识，并提高医疗网络的效率。
