Department of Medicine, 13-103 Clinical Sciences Building, University of Alberta, 11350 - 83 Avenue, Edmonton, Alberta T6G 2P4, Canada.
J Rheumatol. 2012 Apr;39(4):707-11. doi: 10.3899/jrheum.110818. Epub 2012 Feb 15.
To determine the timeliness of consultation and initiation of disease-modifying antirheumatic drugs (DMARD) in patients with rheumatoid arthritis (RA) referred to rheumatologists.
The first part of the study was a review of the charts of 151 patients with RA followed by 3 rheumatologists. The outcome measure was the interval between symptom onset and consultation with a rheumatologist. The second part of the study involved a chart review of 4 family physician practices in a small urban center in order to determine the accuracy of diagnostic coding (International Classification of Diseases; ICD-9) of RA, as well as the proportion of patients with RA seen by a rheumatologist. Finally, a survey was sent to primary care physicians at a group of walk-in clinics to determine what percentage of their patients with RA were referred to a rheumatologist and, concerning referral patterns, how likely it is they would refer a confirmed or suspected RA patient to a rheumatologist.
Patients with RA referred to rheumatologists in this sample were seen by a rheumatologist at a mean of 9.8 months (median 5 mo, range 0-129 mo) after symptom onset, and mean 1.2 months (median 4.0 mo, range 0-8 mo) after being referred by their primary care physician. All referred patients with confirmed RA were started on DMARD within 1 week of initial consultation. Primary care physicians would refer suspected RA patients 99.5% of the time (median 100, range 90-100%), and 87.6% (median 90, range 50-100%) of patients with confirmed RA would have seen a rheumatologist at least once. A chart review showed that, in a select group of family physicians, 70.9% (22/31) of patients coded as RA per the ICD-9 did indeed have RA and all had seen a rheumatologist for their condition.
In Northern Alberta, patients with RA are seen and started on DMARD therapy in a timely fashion. Most of the delay is at the primary care level, suggesting a need for improved education of patients and primary care physicians rather than a formal triage system.
确定类风湿关节炎（RA）患者转诊给风湿病医生时的咨询和开始使用疾病修饰抗风湿药物（DMARD）的及时性。
研究的第一部分是对 151 名 RA 患者的病历进行回顾，由 3 名风湿病医生进行。结局测量指标为症状出现与咨询风湿病医生之间的时间间隔。研究的第二部分涉及对一个小城市中心的 4 个家庭医生诊所的病历回顾，以确定 RA 的诊断编码（国际疾病分类；ICD-9）的准确性，以及由风湿病医生诊治的 RA 患者的比例。最后，向一组门诊诊所的初级保健医生发送了一份调查，以确定他们的 RA 患者中有多少比例被转诊给风湿病医生，以及在转诊模式方面，他们将多大可能将确诊或疑似 RA 患者转诊给风湿病医生。
在本研究样本中，转诊给风湿病医生的 RA 患者在症状出现后平均 9.8 个月（中位数 5 个月，范围 0-129 个月）被风湿病医生诊治，在被初级保健医生转诊后平均 1.2 个月（中位数 4.0 个月，范围 0-8 个月）。所有确诊为 RA 的转诊患者在首次就诊后 1 周内开始使用 DMARD。初级保健医生将 99.5%（中位数 100%，范围 90%-100%）的疑似 RA 患者转诊，87.6%（中位数 90%，范围 50%-100%）的确诊 RA 患者至少看过一次风湿病医生。病历回顾显示，在一组精选的家庭医生中，70.9%（22/31）按 ICD-9 编码为 RA 的患者确实患有 RA，并且所有患者都因该病看过风湿病医生。
在阿尔伯塔省北部，RA 患者得到及时诊治并开始使用 DMARD 治疗。大部分延迟发生在初级保健层面，这表明需要加强对患者和初级保健医生的教育，而不是建立正式的分诊系统。
