Dupuytren's disease presentation, referral pathways and resource utilisation in Europe: regional analysis of a surgeon survey and patient chart review
| Autor: | Piotr Szczypa, Robert A. Gerber, Daniel Guérin, Joseph C. Cappelleri, Lars B. Dahlin, Christopher Bainbridge, C. Leclercq, Joana Alves Dias |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Referral Waiting Lists General Practice MEDLINE Disease Time-to-Treatment Cohort Studies Resource (project management) medicine Humans Surgery Plastic Referral and Consultation Aged business.industry General Medicine Middle Aged Patient Acceptance of Health Care body regions Dupuytren Contracture Europe surgical procedures operative Orthopedics Disease Presentation Family medicine Physical therapy Health Resources Female business Patient chart Cohort study |
| Zdroj: | International journal of clinical practice. 67(3) |
| ISSN: | 1742-1241 |
| Popis: | We explored the management of Dupuytren's disease (DD) using a surgeon survey and patient chart review.Twelve countries participated: Denmark, Finland, Sweden (Nordic region); Czech Republic, Hungary, Poland (East); France, Germany, the Netherlands, United Kingdom (West); Italy, Spain (Mediterranean). A random sample of orthopaedic/plastic surgeons (N = 687) with 3-30 years' experience was asked about Dupuytren's contracture procedures performed during the previous 12 months. Information ≤ 5 consecutive patients per surgeon was extracted from patient charts (N = 3357).Overall, 84% of participants were orthopaedic surgeons; 56% of surgeons were hand specialists. Deciding factors for fasciectomy and dermofasciectomy were consistent across regions: metacarpophalangeal (MP) or proximal interphalangeal contracture45°, recurrent contracture, and high expectations for success. Deciding factors for percutaneous needle fasciotomy were less consistent across regions, but the leading factor was MP flexion20°. Overall, 49% of diagnoses and 55% of referrals were made by a general practitioner (GP), with regional variation: 31-77% for GP diagnoses and 36-81% for GP referrals. There were also differences in admission status (e.g. 9% of Nordic patients and 80% of Eastern patients were treated as inpatients). Most patients were treated in public hospitals and most procedures were covered by public health insurance.We found regional variations in surgical practice, patient characteristics and referral patterns. Understanding current diagnosis and treatment patterns, in relation to regional differences in health economics, may improve physicians' diagnosis of DD and guide patients towards appropriate, customised management plans. |
| Databáze: | OpenAIRE |
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