Ward M M, Rao R
Medical Service, Palo Alto VA Medical Center, CA, USA.
J Rheumatol. 1995 Dec;22(12):2319-26.
To identify factors associated with interruptions in care from rheumatologists among patients with rheumatoid arthritis (RA).
A person-time analysis was used to examine the association of medical insurance status, income, health status, treatment by a primary care physician, and presence of comorbid conditions with interruptions in rheumatology subspecialty care in a cohort of 161 patients with RA followed prospectively for up to 10 years. An interruption was defined as a 6-month period during which a patient was not treated by a rheumatologist. Each patient had at least one interruption.
Interruptions in rheumatology care occurred more commonly during periods when patients reported no medical insurance coverage than when they had medical insurance coverage (relative risk, RR = 1.49; 95% confidence interval, CI = 1.05, 2.11). Interruptions in care were more common during intervals in which patients reported at least a 40% improvement in functional disability (RR = 1.30; 95% CI = 1.03, 1.63), but interruptions were not associated with either absolute or relative changes in pain or global arthritis status. Interruptions in rheumatology care also occurred more commonly during periods when patients reported seeing a primary care physician (RR = 2.07; 95% CI = 1.71, 2.50), and when they reported having a comorbid condition (RR = 1.37; 95% CI = 1.06, 1.77). Income was not associated with interruptions in care.
Lack of medical insurance and short term improvements in functional disability are associated with interruptions in rheumatology care among patients with RA. Patients also appear to substitute primary care for care from rheumatologists. These associations suggest that potential strategies for enhancing continuity in rheumatology care might include the promotion of universal insurance coverage and the development of informational programs for patients.
确定类风湿关节炎（RA）患者中与风湿病专家诊疗中断相关的因素。
采用人时分析，在161例前瞻性随访长达10年的RA患者队列中，研究医疗保险状态、收入、健康状况、初级保健医生的治疗以及合并症的存在与风湿病专科诊疗中断之间的关联。诊疗中断定义为患者未接受风湿病专家治疗的6个月时间段。每位患者至少有一次诊疗中断。
与有医疗保险覆盖期间相比，患者报告无医疗保险覆盖期间，风湿病诊疗中断更为常见（相对风险，RR = 1.49；95%置信区间，CI = 1.05，2.11）。在患者报告功能残疾至少改善40%的期间，诊疗中断更为常见（RR = 1.30；95%CI = 1.03，1.63），但诊疗中断与疼痛或整体关节炎状态的绝对或相对变化均无关。在患者报告看初级保健医生的期间（RR = 2.07；95%CI = 1.71，2.50）以及报告有合并症的期间（RR = 1.37；95%CI = 1.06，1.77），风湿病诊疗中断也更常见。收入与诊疗中断无关。
缺乏医疗保险和功能残疾的短期改善与RA患者的风湿病诊疗中断相关。患者似乎也用初级保健替代了风湿病专家的诊疗。这些关联表明，增强风湿病诊疗连续性的潜在策略可能包括推广全民保险覆盖以及为患者制定信息项目。
