青少年特发性关节炎患者需要过渡到成人风湿病学治疗，以维持 DMARD 治疗。
Transition to adult rheumatology care is necessary to maintain DMARD therapy in young people with juvenile idiopathic arthritis.
机构信息
Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Ammerländer Heerstrasse 140, 26111, Germany.
Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Ammerländer Heerstrasse 140, 26111, Germany.
出版信息
Semin Arthritis Rheum. 2017 Oct;47(2):269-275. doi: 10.1016/j.semarthrit.2017.05.003. Epub 2017 May 12.
OBJECTIVE
To evaluate the outpatient health service utilisation of young people (YP) with juvenile idiopathic arthritis (JIA) during transfer from paediatric to adult care in Germany.
METHODS
Based on claims data of a large German statutory health fund (BARMER GEK) we conducted a cohort study of 2008-2014. Insured YP with diagnosis of JIA (ICD: M08 or M09.0) in two quarters at the age of 16 and continuous insurance until the age of 20 were included. Outpatient health care utilisation, prescribed antirheumatic drugs and diagnosis maintenance were analysed over four consecutive years for all YP with JIA and for the subgroup on disease-modifying antirheumatic drugs (DMARDs) at the age of 16.
RESULTS
A total of 256 YP with JIA (67% female) were followed during the transfer period, 115 of them received (DMARDs) at the age of 16. At the age of 20, 30% of all 256 YP utilised adult specialty care, 59% still had a JIA diagnosis and 30% were treated with DMARDs. Of those 115 YP, treated with DMARDs at the age of 16 and in need of follow-up, 49% had visited an adult rheumatologist at the age of 20, 75% had a JIA diagnosis and 56% were on DMARDs. Those 49% YP with successful transfer to adult specialty care had a JIA diagnosis in 93% and were treated with DMARDs in 80%. YP, who were only seen by general practitioners, had a JIA diagnosis in 54% and received DMARDs in 27%.
CONCLUSIONS
One in two YP with JIA and a clear need for ongoing follow-up do not utilise adult rheumatologic care. The maintenance of JIA diagnosis and DMARD therapy depend on the utilisation of specialised care services.
目的
评估德国从儿科向成人护理过渡期间青少年特发性关节炎（JIA）患者的门诊卫生服务利用情况。
方法
基于一家大型德国法定健康基金（BARMER GEK）的索赔数据，我们进行了一项 2008 年至 2014 年的队列研究。纳入年龄在 16 岁时有 JIA（ICD：M08 或 M09.0）诊断且在 20 岁前持续参保的 2 个季度的患者。分析所有 JIA 患者以及 16 岁时使用疾病修饰抗风湿药物（DMARDs）的亚组患者在连续 4 年内的门诊卫生保健利用情况、开具的抗风湿药物以及诊断维持情况。
结果
在转移期间，共对 256 名 JIA 患者（67%为女性）进行了随访，其中 115 名患者在 16 岁时接受了（DMARDs）治疗。20 岁时，所有 256 名患者中有 30%使用了成人专科护理，59%仍有 JIA 诊断，30%接受了 DMARDs 治疗。在 16 岁时接受 DMARDs 治疗且需要随访的 115 名患者中，49%在 20 岁时就诊于成人风湿病学家，75%有 JIA 诊断，56%接受 DMARDs 治疗。这 49%成功转至成人专科护理的患者中，93%有 JIA 诊断，80%接受 DMARDs 治疗。仅接受全科医生治疗的患者中，54%有 JIA 诊断，27%接受 DMARDs 治疗。
结论
每两个有明确持续随访需求的 JIA 青少年中，就有一个不利用成人风湿病学服务。JIA 诊断和 DMARD 治疗的维持取决于专科保健服务的利用情况。
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