title: Interruptions in rheumatology subspecialty care among patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To identify factors associated with interruptions in care from rheumatologists among patients with rheumatoid arthritis (RA).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medical Service, Palo Alto VA Medical Center, CA, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Ward
authors.forename: R
authors.initials: R
authors.lastname: Rao
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000628:therapy*; D002140:California; D015331:Cohort Studies; D015897:Comorbidity; D003266:Continuity of Patient Care; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009819:Office Visits; D010147:Pain Measurement; D012044:Regression Analysis; D012219:Rheumatology