Background Even though hospitalization is a major cost driver in patients with rheumatic disorders there is limited information and analysis of reasons for their hospitalization
Objectives To analyze the reasons for hospitalization of rheumatologic patients in divisions of rheumatology in emergency hospitals in Switzerland based on questionnaires sent to the heads of all 30 departments of rheumatology in the country
Methods The questionnaires contained 51 open questions on 8 different topics: Which criteria are important for hospitalization? What defines a severe course of the disease? Which threatening organic damage or pain level require hospitalization? How does the complexity of diagnostics or interventions influence the decision for hospitalization? Are costs or primary patient care relevant factors for hospitalization?
The questions were asked in separate for inflammatory arthritis/spondyloarthritides (Art), connective tissue diseases/vasculitis (Vasc), and degenerative or other musculoskeletal disease. (Degen).
Results 25 of the 30 heads of divisions (83.3%) have answered the questionnaires. Two additional ones have sent letters stating that such questionnaires are too limiting for adequately reflecting the clinical reality. The overall majority of responders stated that acute organic problems 79.6% (Art), 81.2% (Vasc), and 73.5% (Degen) are an important factor for hospitalization. These manifestations were closely associated with other primary diseases (Art, 81.8%), with organic manifestations of the primary disease (Vasc, 64.2%), and with complex interventions (Degen, 66.9%). The most important other diagnoses in association with a rheumatologic diagnosis were pneumologic (16.8%), neurologic (13.0%), and cardiological (13%) for Art patients, pneumologic (16.8%), neurologic (13.0%), and renal (13%) for Vasc patients, and neurologic (74.2%) for Degen patients. Primary care problems were understood to be more important for Art (52.6%) and Vasc patients (54.1%), but less important for Degen patients (28.6%).
Conclusions Acute medical rather than chronic problems are the major factor for the hospitalization of rheumatic patients. These acute problems are mainly associated with primary manifestations of other diseases for patients with inflammatory arthritis/spondyloarthritides, with organ manifestations of the primary disease for patients with connective tissue diseases/vasculitis, and with interventions for patients with degenerative or other musculoskeletal disease.
Discussion Since many rheumatologic diseases are closely associated with other diseases, especially of internal organs, it is possible that many of these patients are not seen by a rheumatologist during their hospitalization.
Disclosure of Interest None Declared