From the Division of Rheumatology, Department of Medicine, and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; Department of Medicine and Research Methods Unit, Queen Elizabeth II Health Sciences Centre and Dalhousie University; Atlantic Clinical Cancer Research Unit, Capital Health, Halifax; Nova Scotia, Canada; Health Economics Group, Norwich Medical School, University of East Anglia, UK.
J.G. Hanly, MD, FRCPC, Rheumatologist, Division of Rheumatology, Department of Medicine, and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University; K. Thompson, MSc, Biostatistician, Department of Medicine and Research Methods Unit, Queen Elizabeth II Health Sciences Centre and Dalhousie University; C. Skedgel, PhD, Health Economist, Atlantic Clinical Cancer Research Unit, Capital Health, and Health Economics Group, Norwich Medical School, University of East Anglia.
J Rheumatol. 2017 Oct;44(10):1421-1428. doi: 10.3899/jrheum.170056. Epub 2017 Aug 1.
To determine total physician encounters, emergency room (ER) visits, and hospitalizations in an incident cohort of rheumatoid arthritis (RA) cases and matched control patients over 13 years.
A retrospective cohort study was performed using administrative healthcare data from about 1 million people with access to universal healthcare. Using the International Classification of Diseases, 9th ed (ICD-9) and ICD-10 diagnostic codes, 7 RA case definitions were used. Each case was matched by age and sex to 4 randomly selected controls. Data included physician billings, ER visits, and hospital discharges over 13 years.
The number of incident RA cases varied from 3497 to 27,694, depending on the case definition. The mean age varied from 54.3 to 65.0 years, and the proportion of women from 67.8% to 71.3%. The number of physician encounters by patients with RA was significantly higher than by controls. It was highest in the index year and declined promptly thereafter for all case definitions and by 12.2%-46.8% after 10 years. Encounters with subspecialty physicians fell by 61% (rheumatologists) and 34% (internal medicine). In contrast, clinical encounters with family physicians and other physicians fell by only 9%. Visits to the ER and hospital admissions were also significantly higher in RA cases, particularly early in the disease, and fell significantly over the followup.
In patients with RA, healthcare use is highest in the first year following the diagnosis, which is also the time of maximal involvement by rheumatologists. Use declines over time, and encounters with patients' family physicians predominate over other physician groups.
在类风湿关节炎 (RA) 病例的发病队列和匹配的对照患者中，确定 13 年内总的医生就诊次数、急诊就诊次数和住院治疗次数。
采用来自约 100 万享有全民医疗保健的人群的医疗保健管理数据，进行了一项回顾性队列研究。使用 9 版国际疾病分类 (ICD-9) 和 ICD-10 诊断代码，采用了 7 种 RA 病例定义。每个病例按年龄和性别与 4 名随机选择的对照相匹配。数据包括 13 年内的医生账单、急诊就诊和医院出院情况。
根据病例定义，RA 新发病例的数量从 3497 例到 27694 例不等。平均年龄从 54.3 岁到 65.0 岁不等，女性比例从 67.8%到 71.3%不等。RA 患者的医生就诊次数明显高于对照组。所有病例定义中，在指数年内就诊次数最高，此后迅速下降，10 年后下降 12.2%-46.8%。与风湿病医生的就诊次数下降了 61%（风湿病医生）和 34%（内科医生）。相比之下，与家庭医生和其他医生的临床就诊次数仅下降了 9%。RA 患者的急诊就诊和住院治疗也明显更高，尤其是在疾病早期，且随着随访时间的推移显著下降。
在 RA 患者中，诊断后第一年的医疗保健使用量最高，也是风湿病医生参与最多的时期。随着时间的推移，使用量逐渐下降，患者的家庭医生就诊次数超过其他医生群体。
