The short-term health outcome of out-patient rheumatology consultations in relation to rationing : A pilot study.
The objectives were to test whether the short-term health outcome of rheumatology out-patients differs according to clinical priority.
The setting was an NHS regional rheumatology out-patient department serving a catchment population of over 1 million.
The subjects were 249 consecutive rheumatology out-patients categorized on the basis of the referral letter as'urgent' (n=50), soon' (n=100) or'routine' (n=99).
Primary outcome measures were the proportion of patients reporting improvement in health categorized by clinical priority (urgent, soon or routine) or main diagnostic group (inflammatory or non-inflammatory disease).
Secondary outcome was change in health status measured using the EuroQol generic health instrument (EQ-5D).
Small but insignificant differences in the proportion of patients reporting health improvement were found between the urgent (28%), soon (23%) and routine (17%) categories (Kruskal-Wallis, P=0.186).
Thirty per cent of patients with inflammatory joint disease reported improvement compared with 17% of those with non-inflammatory conditions (Mann-Whitney U, P=0.019).
In patients reporting improvement, the median (interquartile range) improvement in EQ-5D health utility score was+0.2 (0.58) (P=0.0001) and that of visual analogue health score was+5 (16) (P=0.001).
Clinical priority setting, by giving priority to some patients over others, results in rationing by delay. (...)
Mots-clés Pascal : Rhumatologie, Symptomatologie, Malade, Ambulatoire, Audit, Analyse quantitative, Pronostic, Court terme, Politique sanitaire, Epidémiologie, Homme
Mots-clés Pascal anglais : Rheumatology, Symptomatology, Patient, Ambulatory, Audit, Quantitative analysis, Prognosis, Short term, Health policy, Epidemiology, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0286827
Code Inist : 002B15I. Création : 27/11/1998.