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Original Article
DOI: 10.1016/j.reumae.2021.04.004
Available online 14 September 2021
Usefulness of rheumatology consultancy in situ: Analysis of a long-term experience
Utilidad de la consultoría reumatológica in situ: análisis de una experiencia prolongada en el tiempo
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Jesús Tornero-Molinaa,b,
Corresponding author
jtorneromolina@ser.es

Corresponding author.
, María Luisa Díez-Andrésc, Fernando Alonsod, Cintia de la Llana-Calvoc, Susana Luengo Rojoe, Elena Casado Silvestrec, Raquel Grado Sanzc
a Servicio de Reumatología, Hospital General Universitario de Guadalajara, Guadalajara, Spain
b Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá de Henares, Alcalá de Henares, Spain
c Centro de Salud Cervantes, Gerencia de Atención Integrada, Guadalajara, Spain
d Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
e Centro de Salud Pastrana, Gerencia de Atención Integrada, Guadalajara, Spain
Received 08 March 2021. Accepted 28 April 2021
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Tables (4)
Table 1. Main results of the analysis of the usefulness of rheumatology consultancy in situ: a descriptive study.
Table 2. Odds ratio of rheumatic patients attended at the health centre consultancy of continuing follow-up by the primary care physician compared to other care destinations (multivariate adjusted model).
Table 3. Odds ratio of rheumatic patients attended at the health centre consultancy of continuing follow-up by the primary care physician versus follow-up in rheumatology specialty (multivariate adjusted model).
Table 4. Odds ratio of rheumatic patients attended at the health centre consultancy of continuing follow-up in the specialty of rheumatology versus the other care destinations analysed (multivariate adjusted model).
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Abstract
Objective

To report the long-term experience of a rheumatologist consultant “in situ” (RCI) in a primary care centre (PCC).

Material and methods

Observational retrospective study analysing the complete cohort of the patients seen by the RCI between 2013 and 2019. Rheumatology patients’ clinical characteristics and course of care were collected to estimate the diagnoses that were most likely to be monitored by a primary care physician (PCP).

Results

A total of 876 consultations were attended; 205 were men (23.4%) and 671 women (76.6%).Most of the consultations (280, 33.2%) were diagnostic. On 167 occasions (19.8%) therapeutic issues were analysed; in 47 (5.6%) therapeutic infiltrations were performed. Chronic patient control was applied in 163 subjects (19.3%). A request for tests not available to the PCP was the reason for the consultation in 154 situations (18.3%). The profile most likely to continue being monitored in the PCC is the patient with osteoarthritis (OR = .13, CI 95%: .02–.67), soft tissue rheumatism (OR = .006, 95% CI: .01–.45) or cervical disc herniation (OR = .13, 95% CI: .02–.66). Less likely to be monitored by PCP after being seen by the RCI were subjects with rheumatoid arthritis (OR = .03, 95% CI: .00–.24), other inflammatory arthropathies (OR = .36, 95% CI: .16–.80) or with polymyalgia rheumatica (OR = .19, 95% CI: .06-.64 ), and those in need of chronic disease monitoring (OR = .16, 95% CI: .07–.34).

Conclusions

The RCI makes it easier for the PCP to monitor patients with osteoarthritis, soft tissue rheumatism and cervical disc pathology.

Keywords:
Rheumatologist consultant
Primary care
Care coordination
Resumen
Objetivo

Estudiar la utilidad a largo plazo de un reumatólogo consultor “in situ” (RCI) en un centro de Salud (CS).

Material y métodos

Estudio observacional retrospectivo sobre la cohorte completa de pacientes atendidos entre 2013 y 2019, analizando variables clínicas y de curso asistencial, intentando perfilar qué diagnósticos de los pacientes reumáticos tenían más probabilidades de continuar su atención en el CS por el médico de Atención Primaria (MAP).

Resultados

Se atendieron 876 consultas; 205 (23,4%), varones y 671 (76,6%), mujeres; edad media: 64,1 años (DE = 16,6). La mayoría de las consultas (280, 33,2%) fueron diagnósticas. En 167 ocasiones (19,8%) se abordaron temas terapéuticos; en 47 (5,6%) se realizaron infiltraciones. La petición de pruebas no disponibles para el MAP se verificó en 154 situaciones (18,3%). El perfil de paciente con más opciones de continuar su seguimiento por el MAP en el CS es el portador de artrosis (OR = 0,13, IC 95%: 0,02–0,67), reumatismo de partes blandas (OR = 0,06, IC 95%: 0.01–0.45) o hernia discal cervical (OR = 0,13, IC 95%: 0,02–0,66 ). Los pacientes con menos probabilidades de seguimiento por MAP tras su paso por RCI son los portadores de artritis reumatoide (OR = 0,03, IC 95%: 0,00–0,24 ), otras artropatías inflamatorias (OR = 0,36, CI 95%: 0,16–0,80) o con polimialgia reumática (OR = 0,19, IC 95%:0,06–0,64); también los que necesitan de control de enfermo crónico (OR = 0,16, IC 95%: 0,07–0,34).

Conclusiones

El RCI facilita el seguimiento por el MAP de la artrosis, reumatismos de partes blandas y de la dicopatía cervical; le permite disponer de determinadas pruebas complementarias para el diagnóstico.

Palabras clave:
Reumatólogo consultor
Atención Primaria
Coordinación asistencial

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