Quality of rheumatoid arthritis care: the patient's perspective.
OBJECTIVE
To identify health care aspects of inadequate quality in rheumatoid arthritis (RA) care from the perspective of patients, and to study to what extent patients' perspectives on quality of care are associated with patient characteristics.


METHODS
Cross-sectional questionnaire survey performed in 1999.


METHODS
Secondary and tertiary rheumatology outpatient clinics.


METHODS
A random sample (n = 683) of patients diagnosed with rheumatoid arthritis according to the 1987 revised American College of Rheumatology criteria. Patients varied widely with respect to age (mean 61.5 years) and disease duration (mean 10.7 years).


METHODS
Using the method of the QUOTE-questionnaire, patients' were asked to rate the importance to them of 29 aspects of care, and to rate the performance of five different health care providers [i.e. rheumatologist, general practitioner (GP), physiotherapist, home nurse, and formal home help] relating to these aspects. To identify aspects of inadequate quality, patients' performance ratings were weighted by importance ratings within each health care service. Inadequate performance on an extremely important aspect was found to be a more serious quality problem than an inadequate performance on an aspect that was less important to patients. Using regression analyses, the association between patients' quality ratings and patient characteristics was assessed.


RESULTS
Several aspects of inadequate quality were identified, namely in the field of knowledge of rheumatism and particularly for GPs, physiotherapists, home nurses, and formal home help, and in the field of information on medication and treatment for rheumatologists and GPs. Furthermore, for the majority of the importance and performance ratings, we found no association with patient-related characteristics.


CONCLUSIONS
Our study demonstrated that the quality of care could be improved further from the perspective of patients. These findings may be used for making health care more responsive to patients' needs.
Jacobi
Catharina E
CE
Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. c.e.jacobi@lumc.nl
Boshuizen
Hendriek C
HC
Rupp
Ines
I
Dinant
Huibert J
HJ
van den Bos
Geertrudis A M
GA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care; D012044:Regression Analysis; D011795:Surveys and Questionnaires