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Centre characteristics determine ambulatory care and referrals in patients with spondyloarthritis

  • Health Services Research
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Abstract

Objective

To describe the variability in rheumatology visits and referrals to other medical specialties of patients with spondyloarthritis (SpA) and to explore factors that may influence such variability.

Methods

Nation-wide cross-sectional study performed in 2009–2010. Randomly selected records of patients with a diagnosis of SpA and at least one visit to a rheumatology unit within the previous 2 years were audited. The rates of rheumatology visits and of referrals to other medical specialties were estimated—total and between centres—in the study period. Multilevel regression was used to analyse factors associated with variability and to adjust for clinical and patient characteristics.

Results

1168 patients’ records (45 centres) were reviewed, mainly ankylosing spondylitis (55.2 %) and psoriatic arthritis (22.2 %). The patients had incurred in 5908 visits to rheumatology clinics (rate 254 per 100 patient-years), 4307 visits to other medical specialties (19.6 % were referrals from rheumatology), and 775 visits to specialised nurse clinics. An adjusted variability in frequenting rheumatology clinics of 15.7 % between centres was observed. This was partially explained by the number of faculties and trainees. The adjusted intercentre variability for referrals to other specialties was 12.3 %, and it was associated with urban settings, number of procedures, and existence of SpA dedicated clinics; the probability of a patient with SpA of being referred to other specialist may increase up to 25 % depending on the treating centre.

Conclusion

Frequenting rheumatology clinics and referrals to other specialists significantly varies between centres, after adjustment by patient characteristics.

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Acknowledgments

The authors want to acknowledge and thank the following colleagues for their significant contribution in the development of the study protocol, electronic database and statistical analysis: César Hernández, María Jesús García de Yébenes, Miguel Ángel Descalzo, Juan Manuel Barrio, Estíbaliz Loza, María Auxiliadora Martín, and Fernando Sánchez. The full list of authors involved in the emAR II study group can be found in the online Appendix (section II). The emAR II study received funding from Abbvie laboratories; the company had no involvement in the study design, data analysis and interpretation or results communication.

Author information

Authors and Affiliations

  1. Sección de Reumatología, Hospital General Universitario de Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain

    Mariano Andrés & Paloma Vela

  2. Sección de Reumatología, Hospital General Universitario de Elda, Alicante, Spain

    Francisca Sivera

  3. Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain

    Sabina Pérez-Vicente

  4. Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain

    Paloma Vela

  5. Instituto de Salud Musculoesquelética (inMusc), Madrid, Spain

    Loreto Carmona

Authors
  1. Mariano Andrés
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  2. Francisca Sivera
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  3. Sabina Pérez-Vicente
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  4. Paloma Vela
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  5. Loreto Carmona
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Consortia

On behalf of the EMAR II study group

Corresponding author

Correspondence to Mariano Andrés.

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Conflict of interest

The authors declare no conflicts of interest in the making of this manuscript.

Ethical approval

All procedures performed were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent from patients was not required due to the retrospective nature of the study.

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Andrés, M., Sivera, F., Pérez-Vicente, S. et al. Centre characteristics determine ambulatory care and referrals in patients with spondyloarthritis. Rheumatol Int 36, 1515–1523 (2016). https://doi.org/10.1007/s00296-016-3544-x

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  • DOI: https://doi.org/10.1007/s00296-016-3544-x

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