RA patients require ‘clinician-intensive care’
MedWire News: Research suggests that patients with rheumatoid arthritis (RA) present a higher burden of care to clinicians than those with other chronic diseases, due to a greater reliance on patient history and physical examination.
"Confirmation and extension of these observations in actual care may have implications for reimbursement and organization of clinical care," say Theodore Pincus (NYU Hospital, New York, USA) and co-authors.
The researchers sent details of an internet survey to 7265 US physicians, including 3542 rheumatologists and 3723 physicians of other specialties, on the relative importance of five clinical encounter components in the diagnosis and management of eight chronic diseases.
The team was asked to classify the clinician-intensive components of vital signs, patient history, and physical examination with the nonclinician-intensive components, laboratory tests, and ancillary studies. The physicians were asked to rate the items as being 0-20%, 21-40%, 61-80%, and 81-100% importance for diagnosis and management, and were allowed to rate components as being of equally important status.
Overall, 154 rheumatologists and 159 nonrheumatologists completed the survey, the team reports in Arthritis and Rheumatism.
The vast majority of physicians stated that vital signs were the most important indicator for the diagnosis and management of hypertension (97 and 96%, respectively), and laboratory tests the most important for diabetes (96 and 96%), and hypercholesterolemia (99 and 97%).
Ancillary studies were ranked as the most important component for diagnosis and management of lymphoma (72 and 74%, respectively), pulmonary fibrosis (93 and 69%), and ulcerative colitis (92 and 58%), with 67% also stating patient history was the most important factor for the inflammatory bowel condition.
For RA, however, diagnosis and management scored highly for both patient history (64 and 74%, respectively), and physical examination (71 and 65%). Congestive heart failure diagnosis scored highly for physical examination (65%) and ancillary studies (61%), whereas its management scored highly for physical examination (62%) and patient history (58%).
Analysis showed that rheumatologists and nonrheumatologists significantly differed in how the components were rated. For example, while physical examination was rated as the most important factor for diagnosis and management by rheumatologists (86 and 80%, respectively), just 55% and 50% of nonrheumatologists agreed with this assessment.
Nevertheless, RA and congestive heart failure were the only two conditions where more than 50% of nonrheumatologists believed patient history and physical examination were the most important components for diagnosis and management.
"Patients whose diseases require greater 'clinician-intensive' information might require longer and more complex visits than patients with diseases in which decisions are based largely on 'non-clinician intensive' information," the researchers observe.
They conclude: "The findings support evidence that care of patients with rheumatic diseases involves a higher burden for doctors than care of patients with many other diseases. These observations appear to support political positions of the [American College of Rheumatology] over many years suggesting that rheumatologists may deserve greater reimbursement."
By Lynda Williams