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NATALIE J. SHIFF, REEM ABDWANI, DAVID A. CABRAL, KRISTIN M. HOUGHTON, PETER N. MALLESON, ROSS E. PETTY, VICTOR M. ESPINOSA, and LORI B. TUCKER ABSTRACT. Objective. Early recognition and treatment of pediatric rheumatic diseases is associated with improved outcome. We documented access to pediatric rheumatology subspecialty care for children in British Columbia (BC), Canada, referred to the pediatric rheumatology clinic at BC Children’s Hospital, Vancouver. Methods. An audit of new patients attending the outpatient clinic from May 2006 to February 2007 was conducted. Parents completed a questionnaire through a guided interview at the initial clinic assessment. Referral dates were obtained from the referral letters. Patients were classified as having rheumatic disease, nonrheumatic disease, or a pain syndrome based on final diagnosis by a pediatric rheumatologist. Results. Data were collected from 124 of 203 eligible new patients. Before pediatric rheumatology assessment, a median of 3 healthcare providers were seen (range 1–11) for a median of 5 visits (range 1–39). Overall, the median time interval from symptom onset to pediatric rheumatology assessment was 268 days (range 13–4989), and the median time interval from symptom onset to referral to pediatric rheumatology was 179 days (range 3–4970). Among patients ultimately diagnosed with rheumatic diseases (n = 53), there was a median of 119 days (range 3–4970) from symptom onset to referral, and 169 days (range 31–4989) from onset to pediatric rheumatology assessment. Conclusion. Children and adolescents with rheumatic complaints see multiple care providers for multiple visits before referral to pediatric rheumatology, and there is often a long interval between symptom onset and this referral. (J Rheumatol First Release Dec 15 2008; doi:10.3899/ jrheum.080514) Key Indexing Terms: JUVENILE IDIOPATHIC ARTHRITIS HEALTH SERVICES NEEDS AND DEMAND PEDIATRIC RHEUMATIC DISEASES From the Division of Pediatric Rheumatology, Department of Pediatrics, University of British Columbia (UBC), Vancouver, BC, Canada. N.J. Shiff, MD, Pediatric Rheumatology Subspecialty Resident, Division of Rheumatology, Department of Pediatrics, UBC; R. Abdwani, MD, Pediatric Rheumatology Consultant, Child Health Department, Sultan Qaboos University Hospital, Oman; D.A. Cabral, MBBS, Clinical Associate Professor of Pediatrics, Head, Division of Rheumatology, Department of Pediatrics, UBC; K.M. Houghton, MD, MSc, Clinical Assistant Professor of Pediatrics, Division of Rheumatology, Department of Pediatrics, UBC; P.N. Malleson, MBBS, Professor of Pediatrics, Division of Rheumatology, Department of Pediatrics, UBC; R.E. Petty, MD, PhD, Professor Emeritus of Pediatrics, Division of Rheumatology, Department of Pediatrics, UBC; V.M. Espinosa, MSc, IT Research Support, Manager, Centre for Applied Health Research and Evaluation, Child and Family Research Institute, UBC; L.B. Tucker, MD, Clinical Associate Professor of Pediatrics, Division of Rheumatology, Department of Pediatrics, UBC. Address reprint requests to Dr. N.J. Shiff, Division of Rheumatology, BC Children’s Hospital, Room K4-120, 4480 Oak Street, Vancouver, BC V6H 3V4. E-mail: nshiff@cw.bc.ca Accepted for publication September 26, 2008. |
