ISSUES OF OUTPATIENT RHEUMATOLOGY CARE FOR CHILDREN IN ST. PETERSBURG (USING THE EXAMPLE OF ST. MARY MAGDALENE CHILDREN'S CITY HOSPITAL № 2)

Abstract

Introduction. The eff ectiveness of providing specialized rheumatological care to the pediatric population directly depends on the completeness and quality of data on the prevalence of rheumatic diseases in children, the analysis of which takes into account not only the number of patients with rheumatic diseases, but also the peculiarities of their course and routing (“portrait” and “pathway” of the patient). Purposes and tasks. Describe the “pathway” and “portrait” of all patients who have applied for an outpatient appointment with a rheumatologist for 5 months. Materials and methods. During outpatient appointments, the rheumatologist recorded the age and gender, the patient’s complaints, the diagnosis of the referral, the previously prescribed therapy, for primary patients it was additionally clarifi ed which specialist referred them for consultation, and whether they had a full primary diagnosis. Based on the results of the admission, the established diagnosis and prescribed therapy were recorded, the frequency of fundamental diff erences in diagnoses and cases of inadequate therapy, the frequency of referrals of patients to emergency and planned hospitalization in the rheumatology department were recorded. Results. The “pathway” and “portrait” of all patients who applied for an outpatient appointment with a rheumatologist for 5 months are presented. Of the 335 receptions conducted, there were 204 (60.9%) initial applications, 131 (39.1%) repeated ones. A fundamental discrepancy between the diagnosis of the referral and the diagnosis established during the consultation was recorded in 53 cases (15.82%). In 15 cases (4.48%), there was a clear inadequacy of the therapy carried out before the consultation with a rheumatologist. Among the 204 patients examined by a rheumatologist initially, only 168 (82.35%) had the minimum necessary laboratory tests, joint radiography in 119 (58.33%), ultrasound examination of joints in 84 (41.18%). Conclusions. It is necessary to increase the provision of outpatient rheumatologists and increase the level of training in the diagnosis and treatment of rheumatic diseases among specialists who perform the functions of rheumatologists in their absence.