Attending and non-attending patients in a real-life setting of an early arthritis clinic: why do people leave clinics and where do they go?
OBJECTIVE
Rheumatologist assessment as early as possible is considered essential for patients with inflammatory joint disease. In our Very Early Arthritis Clinic (VEAC), a substantial proportion of initially included and followed patients later stop attendance in the clinic. We questioned attending (AP) and non-attending patients (NAP) regarding current health status and satisfaction with care as well as reasons for discontinuation and current care received by NAP.


METHODS
VEAC patients first seen between 1996 and 2003 were included. Assessment included the RADAI, HAQ, and visual analogue scales for pain, disease activity, fatigue, satisfaction with current health care. Current (DMARD) treatment was recorded.


RESULTS
Among AP, 87% had rheumatoid arthritis (RA) and 13% non-RA. Of NAP, 37% had RA, 23% non-RA and 40% no more rheumatic disease. Satisfaction with health care concerning rheumatic disease was better in AP than NAP. Likewise, most outcome parameters were better in AP. Substantially more RA patients in the AP than NAP group received DMARDs. Apart from the disappearance of arthritis, logistic reasons were given most frequently for discontinuation of attendance. Less than 10% of NAP indicated dissatisfaction with medical care.


CONCLUSIONS
We found advantages in both disease activity measures and satisfaction with health care for patients receiving continuous care in a highly specialised Rheumatology clinic. Furthermore, different DMARD usage in RA in AP and NAP may indicate significant deficits in treatment quality outside specialist care. Logistic issues associated with access to continuous Rheumatology care for early arthritis patients need improvement.
Department of Internal Mediciene III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria. valerie.nell@meduniwien.ac.at
Valerie
V
Nell-Duxneuner
Lucila Stange
LS
Rezende
Tanja A
TA
Stamm
Mona
M
Duer
Josef S
JS
Smolen
Klaus P
KP
Machold
D000328:Adult; D000368:Aged; D001168:Arthritis / Q000175:diagnosis / Q000628:therapy*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000628:therapy*; D001317:Austria; D016009:Chi-Square Distribution; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D012074:Remission Induction; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome