Pediatric Rheumatology Online Journal → August 2003 → Health-Care Delivery → Abstract #175

A COMPARISON.OF PAEDIATRIC VS ADULT RHEUMATOLOGY CLINICS. (1) THE DOCTOR PERSPECTIVE

L. P. Robertson,¹ P. Hickling,¹ P. Davis,² K. Bailey,² C. A. J. Ryder,² J. E. McDonagh.²

¹Dept of Rheumatology, Derriford Hospital, Plymouth, Devon, United Kingdom; ²Dept of Paediatric Rheumatology, Diana, Princess of Wales Childrens' Hospital, Birmingham, United Kingdom

Background
Transitional care for adolescents with chronic rheumatic disease involves preparation for transfer to adult rheumatology clinics. The differences between paediatric and adult clinics need acknowledgement. The objective of this study was to compare paediatric and adult rheumatology consultations.
Methods
Consecutive physician outpatient consultations for paediatric and adult rheumatology clinics were examined. Demographic characteristics, the number of people in the consulting room and the length of the consultation were recorded. Patients completed a child or adult health assessment questionnaire (CHAQ or HAQ). Clinics were compared for the number of people in the room, length of consultations (unpaired t-test) and proportions of pts seen alone (chi-squared test).
Results
Data from 150 paediatric and 117 adult consultations was collected (8 vs 19 pts per clinic respectively). Mean age and M:F ratio 10.1±4.96yrs, 1:1.9 (paeds), 54.68±15.98yrs, 1:1.8 (adults). Most frequent diagnoses: juvenile idiopathic arthritis (78.6%), rheumatoid arthritis (36%). Median CHAQ score (available for 96/150 pts) was 0.63 (range: 0 - 2.8), median HAQ (available for 81/117 pts) 1.125 (range: 0 - 2.875). 6% of all paediatric pts and 26.7% (n=8/30) of pts 15yrs were seen alone. 41% attended with their mother, 38% with both parents. The proportion of older teenagers seen alone was lower than adults (p0.001). 74.3% (n=87) of adult patients attended alone. Mean total number of people in the consulting room (incl. doctor and patient) was 3.89±0.87 (paeds) vs 3±0.6 (adults) p0.001. Mean consultation times were 33.9±14.61 mins (paeds) vs 14.66±9.31 mins (adults) p0.001.
Conclusions
There are significantly more people in the consulting room in paediatric clinics. Adult clinics had more patients and shorter consultations. These issues have implications for consultation dynamics, service provision and the preparation of older teenagers for transfer to the adult rheumatology setting.