Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
BMJ Open Qual. 2021 Mar;10(1). doi: 10.1136/bmjoq-2020-001061.
One-third of primary care providers (PCPs) refer patients with fibromyalgia or chronic pain (FM/CP) to specialist care, typically rheumatology. Yet, comprehensive data on the quality of rheumatology care for patients with FM/CP are currently lacking.
Records of patients referred for rheumatology consultation for FM/CP and seen at a single academic centre between 2017 and 2018 were extracted by retrospective chart review. Variables were diagnostic accuracy (at referral vs consultation), resource utilisation (investigations, medications, medical and allied health referral), direct costs (physician billing, staff salary, investigation fees) and access (consult wait time). Patient experience and referring PCP experience surveys were administered.
79 charts were identified. Following consultation, 81% of patients (n=64) maintained the same diagnosis of FM/CP, 19% (n=15) were diagnosed with regional pain and 0% of patients (n=0) were diagnosed with an inflammatory arthritis or connective tissue disease. Investigations were ordered for 37% of patients (n=29), medication prescribed for 10% (n=8) and an allied health referral provided for 54% (n=43). Direct costs totalled $19 745 (average $250/consult; range $157-$968/consult). Consultation wait time averaged 184 days (range 62-228 days). Out of the seven (64%) responses to the patient experience survey, 86% of patients (n=6) were satisfied with provider communication but the consultation 'definitely' met the expectations of only 57% (n=4). The PCP survey returned an insufficient response rate.
This study found that no patient referred to rheumatology care for FM/CP was diagnosed with an inflammatory arthritis or connective tissue disease. Furthermore, patients with FM/CP experience lengthy wait times for rheumatology care which delay their management of chronic pain. Interdisciplinary and collaborative healthcare models can potentially provide higher quality care for patients with FM/CP.
三分之一的初级保健提供者（PCP）将患有纤维肌痛或慢性疼痛（FM/CP）的患者转介给专家治疗，通常是风湿病学。然而，目前缺乏关于 FM/CP 患者风湿病护理质量的综合数据。
通过回顾性病历审查，提取了 2017 年至 2018 年期间在一家学术中心就诊的因 FM/CP 而接受风湿病学咨询的患者的记录。变量包括诊断准确性（在转诊时与咨询时）、资源利用（检查、药物、医疗和联合健康转诊）、直接成本（医生计费、员工工资、检查费用）和就诊时间（咨询等待时间）。还进行了患者体验和转诊 PCP 体验调查。
确定了 79 份图表。咨询后，81%的患者（n=64）维持了纤维肌痛/慢性疼痛的相同诊断，19%（n=15）被诊断为区域疼痛，0%的患者（n=0）被诊断为炎症性关节炎或结缔组织疾病。为 37%的患者（n=29）开具了检查，为 10%的患者（n=8）开具了药物处方，为 54%的患者（n=43）提供了联合健康转诊。直接费用总计 19745 美元（平均每次咨询 250 美元；范围为 157-968 美元/咨询）。咨询等待时间平均为 184 天（范围为 62-228 天）。在七名（64%）对患者体验调查做出回应的人中，86%的患者（n=6）对提供者的沟通表示满意，但只有 57%（n=4）的患者认为咨询“绝对”满足了他们的期望。PCP 调查的回复率不足。
本研究发现，没有被转介到风湿病学治疗 FM/CP 的患者被诊断为炎症性关节炎或结缔组织疾病。此外，患有 FM/CP 的患者需要长时间等待风湿病学治疗，这延迟了他们对慢性疼痛的管理。多学科和协作的医疗保健模式可以为 FM/CP 患者提供更高质量的护理。
