title: Centre characteristics determine ambulatory care and referrals in patients with spondyloarthritis.
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.
  
  
  CONCLUSIONS
  Frequenting rheumatology clinics and referrals to other specialists significantly varies between centres, after adjustment by patient characteristics.
authors: Sección de Reumatología, Hospital General Universitario de Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain. drmarianoandres@gmail.com.
authors: Mariano
authors: http://orcid.org/0000-0002-0219-9055
authors: M
authors: Andrés
authors: Sección de Reumatología, Hospital General Universitario de Elda, Alicante, Spain.
authors: Francisca
authors: F
authors: Sivera
authors: Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain.
authors: Sabina
authors: S
authors: Pérez-Vicente
authors: Sección de Reumatología, Hospital General Universitario de Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain.|Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain.
authors: Paloma
authors: P
authors: Vela
authors: Instituto de Salud Musculoesquelética (inMusc), Madrid, Spain.
authors: Loreto
authors: L
authors: Carmona
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D025241:Spondylarthritis / Q000628:therapy*; D013167:Spondylitis, Ankylosing / Q000628:therapy*
keywords: Ankylosing spondylitis; Clinic attendance; Referrals; Spondyloarthritis; Variability