title: Health-related quality of life as a main determinant of access to rheumatologic care.
abstract: To evaluate a rheumatology outpatient consultation access system for new patients. New patients seen from April 2005 to April 2006 at our rheumatology clinic (n = 4,460) were included and classified according to their appointment type: ordinary appointments (OA) to be seen within 30 days, urgent appointments (UA) and work disability appointments (WDA) to be seen within 3 days. Age, sex, diagnosis, and health-related quality of life (HRQoL) as determined by the Rosser Index were recorded. Logistic regression models were run to identify factors that contribute to each type of appointment. OA was the method of access for 1,938 new patients, while 1,194 and 1,328 patients were seen through WDA and UA appointments, respectively. Younger male patients, and those with microcrystalline arthritis, sciatica, shoulder, back, or neck pain, were more likely to use the faster access systems (UA or WDA), whereas patients with a degenerative disease were mainly seen through OA (<0.001). Subjects with poor (3.96; 95 % CI, 2.8-5.5) or very poor HRQoL (70.8; 95 % CI, 14.9-334) were strongly associated to visiting a rheumatologist through the WDA or UA access systems, respectively, compared to OA. Age, gender, diagnosis, and mainly health-related quality of life are associated with the referral pattern of access to rheumatologic outpatient care. Among new patients subjects with the worst HRQoL were more likely to access with faster methods (UA or WDA) than those with better HRQoL.
authors.affiliation: Rheumatology Unit, Hospital Clínico San Carlos, Calle Profesor Martin Lagos S/N, 28040 Madrid, Spain. lleon.hcsc@salud.madrid.org
authors.forename: Leticia
authors.initials: L
authors.lastname: Leon
authors.forename: Juan Angel
authors.initials: JA
authors.lastname: Jover
authors.forename: Estibaliz
authors.initials: E
authors.lastname: Loza
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Zunzunegui
authors.forename: Cristina
authors.initials: C
authors.lastname: Lajas
authors.forename: Cristina
authors.initials: C
authors.lastname: Vadillo
authors.forename: Oscar
authors.initials: O
authors.lastname: Fontsere
authors.forename: Luis
authors.initials: L
authors.lastname: Rodriguez-Rodriguez
authors.forename: Cristina
authors.initials: C
authors.lastname: Martinez
authors.forename: Benjamin
authors.initials: B
authors.lastname: Fernandez-Gutierrez
authors.forename: Lydia
authors.initials: L
authors.lastname: Abasolo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D001071:Appointments and Schedules; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis* / Q000523:psychology; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care / Q000592:standards*; D011788:Quality of Life; D012017:Referral and Consultation / Q000592:standards*; D012216:Rheumatic Diseases / Q000175:diagnosis* / Q000523:psychology; D012219:Rheumatology / Q000592:standards*; D012737:Sex Factors; D013030:Spain; D013997:Time Factors; D014850:Waiting Lists