Department of Internal Mediciene III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria.
Clin Exp Rheumatol. 2012 Mar-Apr;30(2):184-90. Epub 2012 Apr 13.
Rheumatologist assessment as early as possible is considered essential for patients with inflammatory joint disease. In our Very Early Arthritis Clinic (VEAC), a substantial proportion of initially included and followed patients later stop attendance in the clinic. We questioned attending (AP) and non-attending patients (NAP) regarding current health status and satisfaction with care as well as reasons for discontinuation and current care received by NAP.
VEAC patients first seen between 1996 and 2003 were included. Assessment included the RADAI, HAQ, and visual analogue scales for pain, disease activity, fatigue, satisfaction with current health care. Current (DMARD) treatment was recorded.
Among AP, 87% had rheumatoid arthritis (RA) and 13% non-RA. Of NAP, 37% had RA, 23% non-RA and 40% no more rheumatic disease. Satisfaction with health care concerning rheumatic disease was better in AP than NAP. Likewise, most outcome parameters were better in AP. Substantially more RA patients in the AP than NAP group received DMARDs. Apart from the disappearance of arthritis, logistic reasons were given most frequently for discontinuation of attendance. Less than 10% of NAP indicated dissatisfaction with medical care.
We found advantages in both disease activity measures and satisfaction with health care for patients receiving continuous care in a highly specialised Rheumatology clinic. Furthermore, different DMARD usage in RA in AP and NAP may indicate significant deficits in treatment quality outside specialist care. Logistic issues associated with access to continuous Rheumatology care for early arthritis patients need improvement.
风湿科医生尽早对炎性关节疾病患者进行评估被认为是至关重要的。在我们的早期关节炎诊所（VEAC）中，最初纳入并随访的患者中有相当一部分后来停止在诊所就诊。我们询问了就诊患者（AP）和未就诊患者（NAP）的当前健康状况和对护理的满意度，以及他们停止就诊的原因以及 NAP 目前接受的护理。
纳入 1996 年至 2003 年间首次就诊于 VEAC 的患者。评估包括 RADAI、HAQ 和视觉模拟量表，用于评估疼痛、疾病活动度、疲劳和对当前医疗保健的满意度。记录当前（DMARD）治疗情况。
AP 中 87%为类风湿关节炎（RA），13%为非 RA。NAP 中 37%为 RA，23%为非 RA，40%无风湿性疾病。AP 对风湿病护理的满意度高于 NAP。同样，AP 的大多数结果参数也更好。AP 组接受 DMARD 治疗的 RA 患者明显多于 NAP 组。除关节炎消失外，逻辑原因是停止就诊的最常见原因。不到 10%的 NAP 表示对医疗护理不满意。
我们发现，在高度专业化的风湿病诊所接受连续护理的患者，在疾病活动度指标和对健康护理的满意度方面均具有优势。此外，AP 和 NAP 中 RA 患者 DMARD 使用的差异可能表明在专科护理之外存在治疗质量的显著缺陷。需要改善与早期关节炎患者获得连续风湿病护理相关的获取途径的逻辑问题。
