Original Article
Variability in Resource Consumption in Patients With Spondyloarthritis in Spain. Preliminary Descriptive Data From the emAR II StudyVariabilidad en el consumo de recursos en pacientes con espondiloartritis en España. Datos descriptivos preliminares del estudio emAR II☆

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Abstract

Objective

Our objective was to describe the variability in the management of spondyloarthritis (SA) in Spain in terms of healthcare resources and their use.

Methods

A review of 1168 medical files of patients seen in randomly selected Spanish hospital rheumatology departments. We analyzed demographic variables and variables related to the consumption of health resources.

Results

The total number of visits to rheumatology were 5908 with a rate of 254 visits/100 patient-years. The total number of visits to rheumatology specialty nurses was 775, with a rate of 39 visits/100 patient-years, and there were 446 hospitalizations, representing a rate of 22 per 100 patient-years. The number of admissions due to SA was 89, with a rate of 18 admissions/100 patient-years. Total visits to other specialists were 4307 with a rate of 200/100 patient-years. The total number of orthopedic surgeries was 41, which leads to a rate of 1.8 surgeries/100 patient-years.

Conclusions

The data regarding visits to the rheumatologist and prosthetic surgery of patients with in Spain are similar to most studies published in our environment, however, other aspects concerning the use of health resources are different compared to other countries. These data may help to understand and improve organizational aspects of management of SA in Spanish hospitals.

Resumen

Objetivo

Describir la variabilidad en el manejo de las espondiloartritis (EsA) en España en términos de consumo de recursos sanitarios y la utilización de técnicas.

Métodos

Revisión de 1.168 historias clínicas de pacientes con EsA atendidos en servicios de reumatología de hospitales españoles, seleccionadas aleatoriamente. Se analizaron las variables sociodemográficas y las variables relacionadas con el consumo de recursos sanitarios.

Resultados

El número total de visitas médicas a reumatología fue de 5.908, con una tasa de 254 consultas/100 pacientes-año. El número total de visitas a enfermería reumatológica fue de 775, con una tasa de 39 visitas/100 pacientes-año, y se produjeron 446 ingresos, lo que representa una tasa de 22 por 100 pacientes-año. El número de ingresos debidos a la EsA fue de 89, con una tasa de 18 ingresos/100 pacientes-año. El total de visitas a otros especialistas fue de 4.307, con una tasa de 200/100 pacientes-año. El número total de cirugías ortopédicas fue de 41, lo que da lugar a una tasa de 1,8 cirugías/100 pacientes-año.

Conclusiones

Los datos de visita al reumatólogo y de cirugía protésica de pacientes con EsA en España son similares a la mayoría de los estudios publicados en nuestro entorno; sin embargo, otros aspectos referentes al uso de recursos sanitarios son diferentes en comparación con otros países. Estos datos pueden contribuir para conocer y mejorar aspectos organizativos del manejo de la EsA en los hospitales españoles.

Introduction

The eMAR II study is a study of variability in the treatment of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Spain. We define variability in clinical practice as the differences within a group of patients in relation to any aspect of the same clinical practice.

Variability of clinical practice is a very common phenomenon in medicine, and is responsible for the improper use of different procedures, with a subsequent unnecessary use of resources and possible collateral damage to the patient and costs for the health system.1, 2, 3, 4, 5, 6, 7, 8 These reasons justify the need to understand variability, its determinants and effects, in order to design realistic strategies to help improve the quality of clinical practice.

In this sense, the results of the first study of variability in the treatment of RA in Spain (eMAR I), made 10 years ago, showed a wide variability in the use of different health resources, diagnostic procedures and therapeutic monitoring of patients with RA who, in many cases, is independent of the characteristics of the patient or the severity of the disease.7, 8

In the 10 years since the eMAR I, care for RA and other inflammatory joint diseases type has undergone a revolution due to various factors including the availability of new treatments, better understanding of these processes, the growth of rheumatology care in our country and the development of other important research. The eMAR II evaluates the potential impact of these events in the practices of management of RA and in SpA. In the latter group of diseases has been is poorly studied.9, 10 The objective of this paper is to describe the variability in the management of SpA in Spain in terms of healthcare resource utilization (physician visits, hospitalizations, etc.) and the use of techniques (radiography, ultrasound, etc.). The results of this study may serve greatly in the constant improvement of management of patients in our country.

Section snippets

Design, Patient Selection and Data Acquisition

The eMAR II study (2009–2010) is a cross-sectional study designed to analyze variability in the management of patients with RA in Spain.11 100 hospitals were contacted, 46 accepted and 54 rejected participation.

The sample consisted of medical records or files of patients seen in rheumatology departments of Spanish hospitals with at least one visit to a rheumatologist in the 2 years preceding the date of study onset. We performed a stratified random sampling of regions (CC. AA.), of second level

Sociodemographic Characteristics of Patients

Of the estimated sample (n=1410), valid information was obtained for 1168 patients with SpA, which represents 82.8% of the theoretical sample. The origins of the patients in relation to CC. AA. were as follows: Andalucía, Ceuta and Melilla: 204, Asturias, Cantabria and the Basque Country: 77; Balearics and Valencia: 90, Canary 79, Castile and Leon and Extremadura: 148; Castilla-La Mancha and Murcia: 84; Catalonia: 148; Galicia: 23; Madrid: 224, and Navarra, La Rioja and Aragon: 90.

Of the

Discussion

Variability in clinical practice refers to the differences we find in it. That is, patients are not always managed the same way. The variability in clinical practice is admissible if, for example, there is no evidence that a particular technique, system or drug is superior to the rest, when the specific characteristics and preferences of patients so require it, or when resources are not available. However, it is unacceptable when it is caused by deficiencies in the skills of the physician, poor

Ethical disclosures

Protection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this investigation.

Confidentiality of Data. The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.

Right to privacy and informed consent. The authors have

Conflict of Interest

eMAR II study was funded by Abbott Laboratories.

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    ☆

    Please cite this article as: Jovani V, et al. Variabilidad en el consumo de recursos en pacientes con espondiloartritis en España. Datos descriptivos preliminares del estudio emAR II. Reumatol Clin. 2012;8:114-9.

    e

    The band members are listed in Annex 1.

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