Katz J N, Barrett J, Liang M H, Kaplan H, Roberts W N, Baron J A
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Am J Med. 1998 Oct;105(4):312-8. doi: 10.1016/s0002-9343(98)00273-3.
To examine rheumatology subspecialty practice patterns, determinants of referral to rheumatologists, and utilization of aspiration and injection procedures in a population-based sample of elderly individuals.
We obtained Medicare physician claims for all visits to rheumatologists among beneficiaries aged 65 years and older in Colorado, Massachusetts, and Virginia in 1993, and for visits to all providers by patients with coded diagnoses of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We examined variations in visit frequency and aspiration/injection procedures, and we analyzed determinants of referral to a rheumatologist for RA or SLE.
In 1 year, 144,797 visits were made to rheumatologists by 38,443 patients in the three states. An inflammatory disorder was coded in 45% of visits and a noninflammatory disorder in 50%. Half of patients with RA were seen three or fewer times in the year. For RA and SLE, African Americans were about 60% as likely to be seen by a rheumatologist as whites. Utilization of rheumatologist services for rheumatoid arthritis and systemic lupus erythematosus was highest in the state (Virginia) with the lowest per capita supply of rheumatologists. Among patients with bursitis, tendinitis, and osteoarthritis, African-American women were more likely to receive an injection or aspiration procedure than whites or African-American men.
Elderly patients with rheumatologic disorders were seen by specialists less frequently than recommended by a recent rheumatology manpower survey. African-Americans with RA and SLE had fewer rheumatology visits than whites.
在一个以人群为基础的老年样本中，研究风湿病亚专业的实践模式、转诊至风湿病专家的决定因素以及抽吸和注射程序的使用情况。
我们获取了1993年科罗拉多州、马萨诸塞州和弗吉尼亚州65岁及以上受益人群中所有前往风湿病专家处就诊的医疗保险医师索赔数据，以及诊断编码为类风湿关节炎（RA）和系统性红斑狼疮（SLE）的患者前往所有医疗服务提供者处就诊的数据。我们研究了就诊频率和抽吸/注射程序的差异，并分析了RA或SLE患者转诊至风湿病专家的决定因素。
在1年时间里，这三个州的38443名患者共前往风湿病专家处就诊144797次。45%的就诊被编码为炎性疾病，50%为非炎性疾病。一半的RA患者在这一年中就诊次数为3次或更少。对于RA和SLE，非裔美国人被风湿病专家诊治的可能性约为白人的60%。在人均风湿病专家供应量最低的州（弗吉尼亚州），RA和SLE患者对风湿病专家服务的利用率最高。在患有滑囊炎、肌腱炎和骨关节炎的患者中，非裔美国女性比白人或非裔美国男性更有可能接受注射或抽吸程序。
患有风湿性疾病的老年患者被专科医生诊治的频率低于近期风湿病人力调查所建议的频率。患有RA和SLE的非裔美国人比白人接受风湿病诊治的次数更少。
