LAUSR

Background: Analysis of the claims made by patients could be an indicator of quality and show strengths and aspects of improvement in the organization of a rheumatology department Objectives: The aims of the present study are to evaluate these claims, describe the sociodemographic and clinical characteristics of claiming patients and to determine the association between medical history and types of complaints. Methods: cross-sectional study. Claims made by patients treated by a Rheumatology department between 04/2016 and 12/2017 were analyzed. A descriptive analysis of these claims was carried out followed by a multivariate logistic regression model to determine the effect of the diagnosis of Fibromyalgia (FM)/Chronic Widespread Pain (CWP) on the type of claim and its association with clinical variables. A p <0.05 was considered significant. Results: One hundred and nine patients (mean age 54.7 ± 18.5 years, 78% women and 50.5% residents in rural areas) made 113 claims. The main reasons for claiming were: “advance medical evaluation and/or tests” (45.1%), ”request for evaluation by a specific physician” (24.8%) and ”rejection of evaluation by specific physician” (13, 3%). 67% of the claims were satisfied. The least satisfied claims were “request for evaluation by specific doctor” (39.3%) while claims for “cancellation of evaluation” were satisfied in 88% of the cases. Median time between claim and previous medical visit was 99 [34-203] days and between claim and the subsequent medical consultation was 44 [28-82] days. Patients whose claims were due to ”unpleasant attendance” were the first to complaint (median 28 [2-72] days) but waited for the longest time to be attended (median 103 [46-147] days). “Cancellation of evaluation” was attended after a median of 31.5 [28-33] days. The main reasons for medical evaluation were: inflammatory/systemic disease in 25 patients (22.15%), neck and low back pain in 23 patients (20.35%) and FM/CWP also in 20.35% of patients. As personal medical history, Psychiatric Disorders were present in 20.5% of patients and multiple comorbidities in 19.6% of patients. Twenty patients had no medical history of interest. Regarding the type of claims, differences were observed related to the diagnosis and the patient‘s medical history. The logistic regression model (FM as dependent variable) adjusted for sex, age, rural area, time to/after the claim and medical history showed that patients with FM/CWP requested more frequently to “be evaluated by other physician” (OR of 23.92 ( 95% CI, 1.4-409.06) and “reject to be evaluated by a specific physician” (OR of 8.48 (95% CI, 1.2-60.09) than rest of the patients and also presented more frequently with psychiatric history (OR of 22.39 (95% CI, 1.15-437.23) Conclusion: the present study reflects main reasons for claiming of patients treated in a rheumatology department. Reasons of claiming and comorbidities of patients with FM/CWP differ from those of the rest of patients. These findings may be of interest for the organization of resources in rheumatology departments. Disclosure of Interests: Enrique Judez Navarro Consultant for: Roche, Carlos Sánchez-Piedra: None declared, Gines Sanchez Nievas: None declared, Isabel Labiano: None declared, Manuela Sianes: None declared, Gloria Garcia Consuegra: None declared, Sandra Soro: None declared, M Angeles Garcia Morales: None declared