Background Network PR-LR is designed to improve the management of patients with rheumatoid arthritis (RA) in the Languedoc Roussillon (France). It conducts training activities, information for patients and health professionals on rheumatoid arthritis. It now has 1,263 patients. There is an anonymized medical records and computerized for each patient which allows regular monitoring.
Objectives Compare the consumption of medical procedures between patients in or those outside to the network system.
Methods To study the data from RA patients, we asked to the regional health insurance company (RHIC) a list of patients with medical and economic information usable. We gave the health insurance list of patient care within the network. The RHIC has extracted about two years (June 2009-July 2011) a database containing anonymised patient outside the network PR-LR.
Once we got the information from the RHIC, we analyzed several criteria: per diem reimbursement, visits to the doctor, number of visits to specialists, many acts of biology and radiology. Other criteria have not yet been exploited due to lack of data: type of treatment (use of corticosteroids, NSAIDs, DMARDs or biological agents), number of hospitalizations, surgical procedures. For comparison of common variables, we used a Chi2 test.
Results Over the period studied, we obtained 5936 non-network patients versus 465 patients in the network and living in the Languedoc Roussillon. Non-network patients (N=5936) were a mean age of 61.86 years (SD 15.18), duration symptoms RA of 6 years (SD 3.8). There are 1631 men and 4305 women. The sex male/female ratio is 0.37. Patients Network (N=465) had a mean age of 62.49 years (SD 14.71), an unknown length of RA. There are 99 men and 306 women. The sex male/female ratio is 0.27. There is a significant difference between the 2 groups.
In the Network patients group, we observed:
– less diem reimbursement: 13.55 (71.32) vs 22.71 (91.13) p=0.0088
– Fewer visits to the doctor: 10.73 (10.81) vs 13.66 (11.36) p=0.00001
– No difference in the number of specialist consultations: 7.34 (7.62) vs 7.52 (7.11) p=0.1761
– No differences in the number of acts of biology but more likely because follow-up is better: 47.11 (41.16) vs 41.88 (37.06) p=0, 0532
– Less X-ray procedures: 6.78 (6.97) vs 8.55 (8.35) p=0.00001
– Less Radiographs of hands for better monitoring: 0.37 (0.78) vs 0.55 (1.09) p=0.0081. Warning of the date of the last ray is given to the physician
– No differences in the number of radiographs of the feet: 0.55 (1.04) vs 0.49 (0.99) p=0.1897
Conclusions This study has many limitations but shows for the first time a benefit of a network of care on the treatment of RA patients. Better monitoring through the computer interface allows us a better tight control of the patient and a profit on medical consumption shown by the decrease in visits to the doctor, acts of x-rays and the number of per diem reimbursement.
Disclosure of Interest None Declared
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