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Introduction One of the missions of the Spanish Society of Rheumatology is to provide the necessary tools for excellence in health care. Currently, there is no reference point to quantify medical actions in this specialty, and this is imperative. Material and method A list of actions was drawn up and a hierarchical classification system was established by developing a complexity index, calculated based on the completion time and difficulty level of each action. Results The results of the Delphi method tended to the consensus opinion within a group (mean σ2 − σ1 = 0 .75–1.43 = −0.68, mean IQR2–IQR1 = 0.8–1.9 = −1.1). The values of the complexity index ranged between 48 and 465 points. Among consultation actions, those reaching the highest scores were the first inpatient visit (366) and visits to the patient's home (369). Among diagnostic techniques, biopsies were prominent, those with the highest score were: bone biopsy (465), sural nerve biopsy (416) and synovial biopsy (380). Ultrasound scan scored 204, capillaroscopy 113 and densitometry 112. Among therapeutic techniques, infiltration/arthrocentesis/articular injection in children reached the highest difficulty (388). The score for ultrasound-guided articular injection was 163. The score for clinical report on disability was 323 and expert report 370. Conclusions A nomenclature of 54 actions in Rheumatology was compiled. Biopsies (bone, sural nerve, synovial), inpatient visits, visits to the patient's home, infiltrations in children, and the preparation of the expert report were identified as the most complex actions. Musculoskeletal ultrasound is twice as complex as subsequent visits, capillaroscopy or bone densitometry.

espanolIntroduccion Una mision de la Sociedad Espanola de Reumatologia es aportar las herramientas necesarias para alcanzar la excelencia asistencial. En la actualidad no existe una referencia que cuantifique la complejidad de los actos medicos de esta especialidad. Material y metodo Se elaboro una relacion de los actos propios del reumatologo y se establecio un sistema de clasificacion jerarquica a partir de la construccion de un indice de complejidad, calculado mediante el tiempo de realizacion y el grado de dificultad de cada acto. Resultados Los resultados del metodo Delphi tendieron a una opinion grupal consensuada (media σ2 - σ1 = 0,75-1,43 = -0,68, media IQR2 - IQR1 = 0,8-1,9 = -1,1). El rango de valores del indice de complejidad oscilo de 48 a 465 puntos. Entre las consultas, las que alcanzaron mayor gradacion fueron la primera visita al paciente hospitalizado (366) y la visita a domicilio (369). Entre las tecnicas diagnosticas, destacaron las biopsias. Las que puntuaron mas alto fueron: biopsia osea (465), de nervio sural (416) y sinovial (380). La ecografia tuvo una puntuacion de 204, la capilaroscopia de 113 y la densitometria de 112. Entre las tecnicas terapeuticas, la maxima dificultad (388), la alcanzo la infiltracion/artrocentesis/ inyeccion articular infantil. La puntuacion de la inyeccion articular con control ecografico fue de 163. El informe clinico de minusvalia, 323 y el informe pericial, 370. Conclusiones Este trabajo ha permitido elaborar un nomenclator de 54 actos en reumatologia donde se identifican como actos mas complejos la realizacion de biopsias (osea, nervio sural, sinovial), la visita a paciente hospitalizado, la visita a domicilio, la infiltracion infantil bajo sedacion y la elaboracion de un informe pericial. La ecografia osteomuscular es considerada el doble de compleja de una visita sucesiva, la capilaroscopia o la densitometria osea. EnglishIntroduction One of the missions of the Spanish Society of Rheumatology is to provide the necessary tools for excellence in health care. Currently, there is no reference point to quantify medical actions in this specialty, and this is imperative. Material and method A list of actions was drawn up and a hierarchical classification system was established by developing a complexity index, calculated based on the completion time and difficulty level of each action. Results The results of the Delphi method tended to the consensus opinion within a group (mean σ2 - σ1 = 0.75-1.43 = -0.68, mean IQR2 - IQR1 = 0.8-1.9 = -1.1). The values of the complexity index ranged between 48 and 465 points. Among consultation actions, those reaching the highest scores were the first inpatient visit (366) and visits to the patient's home (369). Among diagnostic techniques, biopsies were prominent, those with the highest score were: bone biopsy (465), sural nerve biopsy (416) and synovial biopsy (380). Ultrasound scan scored 204, capillaroscopy 113 and densitometry 112. Among therapeutic techniques, infiltration/ arthrocentesis/articular injection in children reached the highest difficulty (388). The score for ultrasound-guided articular injection was 163. The score for clinical report on disability was 323 and expert report 370. Conclusions A nomenclature of 54 actions in Rheumatology was compiled. Biopsies (bone, sural nerve, synovial), inpatient visits, visits to the patient's home, infiltrations in children, and the preparation of the expert report were identified as the most complex actions. Musculoskeletal ultrasound is twice as complex as subsequent visits, capillaroscopy or bone densitometry.

Resumen Introduccion El Sistema Nacional de Salud ofrece en Espana la atencion reumatologica. Mas de una cuarta parte del gasto sanitario se realiza en medicina privada. En la actualidad no existen datos sobre el numero de reumatologos con actividad privada en Espana. Objetivos Evaluar los reumatologos con actividad privada en Espana describiendo su perfil y localizacion. Material y metodos Desde la Comision de Practica Privada de la SER, se elaboro una encuesta que se envio a todos los socios reumatologos en activo. La recogida de datos finalizo en diciembre del 2014. Se analizaron los datos mediante estadistica descriptiva y se realizo una comparacion de los resultados. Resultados Se obtuvieron 759 respuestas de un total de 980 encuestas enviadas (77,45%). El 38% de los reumatologos espanoles tienen actividad privada; el 13% en exclusiva (privada) y el 25% compartida con su actividad publica (mixta). El perfil del reumatologo que trabaja en la medicina privada es: genero masculino, 49 anos de edad con 19 anos de experiencia, su jornada laboral es de 42 h semanales. Existe un claro predominio de la practica privada en la CC. AA. de Cataluna (28% del total), seguida por las CC. AA. de Madrid con un 18%, Andalucia con un 12% y Valencia con un 8%. Conclusiones El 38% de los reumatologos espanoles trabajan en la medicina privada. El perfil profesional en reumatologia privada es distinto del que trabaja exclusivamente en la sanidad publica. Existe reumatologia privada en todas las CC. AA, aunque la mayoria de reumatologos privados se localizan en las CC. AA. de Cataluna, Madrid, Valenciana y Andalucia, representando mas del 50% del total.

Introduction Rheumatologic care is offered by the National Health System in Spain. However, more than a quarter of health spending is carried out in private medicine. Currently, there are no data about the number of rheumatologists with private activity in Spain. Objectives To evaluate the number of rheumatologists with private activity in Spain and to describe the profile and location of these professionals. Material and methods A survey was developed and sent from the SER Commission on Private Practice to all SER active members. Data collection ends in December 2014. A descriptive statistical analysis and comparison of results was done. Results 759 answers from a total of 980 surveys sent (77.45%) were obtained; 38% of Spanish rheumatologists have private activity; 13% exclusively private practice and 25% private practice shared with his or her public activity. The private practice rheumatologist profile is: male, 49 years old with 19 years of experience after finishing the specialty and with a working day of 42 h per week. There is a clear predominance of private practice in the Autonomous Community of Catalonia with 28% of the total, followed by Madrid 18%, Andalusia 12% and Valencia 8%. Conclusions 38% of Spanish rheumatologists are working in private practice. The profile of professionals working in private practice is different from that of those who work exclusively in public health. Private rheumatology is located in all regions, although most private rheumatologists are located in the regions of Catalonia, Madrid, Valencia and Andalusia, representing more than 50% of the total.