在肌肉骨骼临床评估和治疗服务 (CATS) 接受治疗后的复诊、自我报告的健康状况和费用：一项为期 12 个月的前瞻性队列研究。

Reconsultation, self-reported health status and costs following treatment at a musculoskeletal Clinical Assessment and Treatment Service (CATS): a 12-month prospective cohort study.

机构信息

Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK Staffordshire Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK.

Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.

出版信息

BMJ Open. 2016 Oct 12;6(10):e011735. doi: 10.1136/bmjopen-2016-011735.

DOI:10.1136/bmjopen-2016-011735

PMID:27733409

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5073523/

Abstract

OBJECTIVES

To determine (1) reconsultation frequency, (2) change in self-reported health status, (3) baseline factors associated with reconsultation and change in health status and (4) associated healthcare costs and quality-adjusted life-years (QALYs), following assessment at a musculoskeletal Clinical and Assessment Treatment Service (CATS).

DESIGN

Prospective cohort study.

SETTING

Single musculoskeletal CATS at the primary-secondary care interface.

PARTICIPANTS

2166 CATS attenders followed-up by postal questionnaires at 6 and 12 months and review of medical records.

OUTCOME MEASURES

Primary outcome was consultation in primary care with the same musculoskeletal problem within 12 months. Secondary outcome measures were consultation at the CATS with the same musculoskeletal problem within 12 months, physical function and pain (Short Form-36), anxiety and depression (Hospital Anxiety and Depression Scale), time off work, healthcare costs and QALYs.

RESULTS

Over 12 months, 507 (38%) reconsulted for the same problem in primary care and 345 (26%) at the CATS. Primary care reconsultation in the first 3 months was associated with baseline pain interference (relative risk ratio 5.33; 95% CI 3.23 to 8.80) and spinal pain (1.75; 1.09 to 2.82), and after 3-6 months with baseline assessment by a hospital specialist (2.06; 1.13 to 3.75). Small mean improvements were seen in physical function (1.88; 95% CI 1.44 to 2.32) and body pain (3.86; 3.38 to 4.34) at 6 months. Poor physical function at 6 months was associated with obesity, chronic pain and poor baseline physical function. Mean (SD) 6-month cost and QALYs per patient were £422.40 (660.11) and 0.257 (0.144), respectively.

CONCLUSIONS

While most patients are appropriate for a 'one-stop shop' model, those with troublesome, disabling pain and spinal pain commonly reconsult and have ongoing problems. Services should be configured to identify and address such clinical complexity.

摘要

目的

确定（1）复诊频率，（2）自我报告健康状况的变化，（3）与复诊和健康状况变化相关的基线因素，以及（4）相关的医疗保健成本和质量调整生命年（QALY），在肌肉骨骼临床和评估治疗服务（CATS）进行评估后。

设计

前瞻性队列研究。

地点

初级-二级保健界面的单一肌肉骨骼 CATS。

参与者

2166 名 CATS 就诊者通过邮寄问卷在 6 个月和 12 个月时进行随访，并查阅病历。

主要结果

主要结果是在 12 个月内，在初级保健中因同一肌肉骨骼问题再次就诊。次要结果是在 12 个月内，因同一肌肉骨骼问题在 CATS 就诊、身体功能和疼痛（36 项简短健康调查）、焦虑和抑郁（医院焦虑和抑郁量表）、休假时间、医疗保健成本和 QALY。

结果

在 12 个月内，有 507 名（38%）因同一问题在初级保健中再次就诊，345 名（26%）在 CATS 就诊。前 3 个月的初级保健复诊与基线疼痛干扰相关（相对风险比 5.33；95%置信区间 3.23 至 8.80）和脊柱疼痛（1.75；1.09 至 2.82），3-6 个月后与医院专科医生的基线评估相关（2.06；1.13 至 3.75）。6 个月时，身体功能（1.88；95%置信区间 1.44 至 2.32）和身体疼痛（3.86；3.38 至 4.34）有较小的平均改善。6 个月时身体功能差与肥胖、慢性疼痛和基线身体功能差有关。每位患者的平均（SD）6 个月成本和 QALY 分别为 422.40（660.11）英镑和 0.257（0.144）。