目的:这篇综述研究了JIA患者获得适当护理的时间,并分析了首次儿科风湿病(PR)就诊前的转诊途径。我们还描述了与更长的转诊相关的因素。
方法:我们进行了系统的文献综述,筛选电子数据库(PubMed,WebofScience,EMBASE,Cochrane图书馆和OpenGrey数据库)至2020年2月。1994年之前(即在引入统一术语JIA之前)撰写的文章被排除在外。
结果:从发现的595个非重复引用中,15篇文章最终被纳入审查。大多数研究发生在欧洲。首次公关就诊的中位时间为3至10个月,转诊途径和患者特征之间存在一些差异。全身发作JIA的患者转诊时间最短。一些临床和生物学因素,如肿胀,发烧,CRP和/或ESR升高与首次PR就诊时间较短相关.相反,附着性炎,症状发作或疼痛的年龄较大与较长的时间相关.无论哪个国家或世界地区,尽管医疗系统组织和医疗从业者可用性存在差异,访问PR的时间并不广泛。
结论:这是总结JIA患者获得PR的研究的第一个系统综述。JIA患者的护理途径仍然很复杂,延迟转诊的原因取决于几个因素。标准化的临床指南和快速通道,以促进迅速转诊到专业团队,必须考虑到全球范围内的医疗保健供应差异。
OBJECTIVE: This
review examines time to access appropriate care for
JIA patients and analyses the referral pathway before the first paediatric rheumatology (PR) visit. We also describe factors associated with a longer referral.
METHODS: We performed a systematic literature
review, screening electronic databases (PubMed, Web of Science, EMBASE, Cochrane library and Open Grey database) up to February 2020. Articles written before 1994 (i.e. before the introduction of the unifying term JIA) were excluded.
RESULTS: From 595 nonduplicate citations found, 15 articles were finally included in the review. Most of the studies took place in Europe. The median time to first PR visit ranged from 3 to 10 months, with some disparities between referral pathway and patient characteristics. Patients with systemic-onset
JIA had the shortest time to referral. Some clinical and biological factors such as swelling, fever, and elevated CRP and/or ESR were associated with a shorter time to first PR visit. Conversely, enthesitis, older age at symptom onset or pain were associated with a longer time. Whatever the country or world region, and despite disparities in healthcare system organization and healthcare practitioner availabilities, times to access PR were not wide-ranging.
CONCLUSIONS: This is the first systematic
review to summarize research on access to PR for
JIA patients. The pathway of care for JIA patients remains complex, and reasons for delayed referral depend on several factors. Standardized clinical guidelines and fast-track pathways to facilitate prompt referral to specialized teams have to allow for worldwide disparities in healthcare provision.