Accessibility and quality of secondary care rheumatology services for people with inflammatory arthritis: a regional survey

Abstract

-Secondary care rheumatology services for patients with inflammatory arthritis (IA) in the West Midlands were audited using Arthritis and Musculoskeletal Alliance (ARMA) standards of care. Questionnaires were analysed from 1,715 patients in 11 rheumatology departments. ARMA standards recommend full multidisciplinary team assessment; referral rates to nurse specialists (52.3%), physiotherapists (48.7%) and occupational therapists (36.5%) were, however, lower than expected. Attendance at existing hospital-led education groups was rare (8.9%), awareness of existing helplines was moderate (59.2%) but the proportion of patients reporting satisfaction with advice about their disease was high (80.5%). Significant variations were found between departments. For patients with IA <2 years (n=236), 84.5% were seen by a rheumatologist within the ARMA standard of 12 weeks of referral; diagnosis of a type of IA was made at the first rheumatology appointment in 66.4%; 82.8% of rheumatoid arthritis patients had commenced disease-modifying drugs, although time to commencement varied across departments. This study raises issues regarding provision of rheumatology services, prioritisation of patient referral and patient education.KEY WORDS: inflammatory arthritis, referral, regional audit, standards of care IntroductionInflammatory arthritis (IA) is an umbrella term for a number of diseases, principally rheumatoid arthritis (RA), psoriatic arthritis and ankylosing spondylitis. Inflammatory arthritis has a huge impact on patients' lives and imposes a heavy financial burden on both the NHS and national productivity. 1,2 There has historically been great variation in provision of services for people with IA in the UK. 3 With major advances in therapy, however, there is a pressing need to evaluate, optimise and integrate services for these individuals. 4 The Arthritis and Musculoskeletal Alliance (ARMA) published standards of care for people with IA in 2004 3 and these have been supported by the RA guidelines from the British Society for Rheumatology. 5,6 Moreover, a Musculoskeletal Services Framework has now been published by the Department of Health, 7 which re-enforces the same principles of fast access to an array of services.The ARMA standards were developed by an expert working group including people with IA, representatives of user organisations, service providers and clinicians. Following a review of needs of people with IA, evidence-based standards were determined to meet those needs with appropriate provision of musculoskeletal services. 3 The standards include ensuring patients with IA are seen by a rheumatology specialist within 12 weeks of referral, with a developmental standard of six weeks (Standard 4). This is crucial since early, intensive treatment with disease-modifying anti-rheumatic drugs (DMARDs) improves outcome for some types of IA, especially RA. [8][9][10] Access to and full assessment by members of a rheumatology Accessibility and quality of secondary care rheumatology services for people with inflam...

System Integration and Clinical Utilization of the Advanced Clinician Practitioner in Arthritis Care (ACPAC) Program–Trained Extended Role Practitioners in Ontario: A Two-Year, System-Level Evaluation

“…The complex, often multi-system nature of inflammatory joint diseases and the variety of health professionals involved in the management of these diseases present challenges with care provision 11 . In addition to medications, evidence-based practice for arthritis management recommends a variety of non-pharmacological interventions based on disease-type, including orthopaedic surgery, rehabilitation and exercise, and patient self-management 78 .…”

“…Specialist services such as rheumatology are part of a comprehensive approach to arthritis management, particularly for rheumatoid arthritis [2][3][4] . Access to rheumatology services and early treatment (within three months of symptom onset) for individuals with rheumatoid arthritis is important, as delays in therapy initiation may adversely affect disease activity, remission and functional capacity [5][6][7][8][9][10][11] . Continuing care from a rheumatologist is important, as lack of referral to a rheumatologist leads to progressively increasing functional disability in individuals with rheumatoid arthritis 12 .…”

Eight years’ experience of regional audit: an assessment of its value as a clinical governance tool

“…Specific examples include that a regional audit helped in the business case for a local osteoporosis service, 9 provided data for negotiations with the local primary care trust to fund eligible patients with biologic therapy, 11 re-educated staff about avoiding unnecessary dual energy X-ray absorptiometry scans, 12 supported the commencement of annual review clinics 13 Authorship Author on a regional audit publication 77…”

“…Corticosteroid-induced-osteoporosis RCP steroid audit 13 2,609 prophylaxis guidance (2002) 12 ARthritis and Musculoskeletal Alliance standards of care guidance (2004) 13 • The audit report is presented locally, regionally and nationally and is published in a peer-reviewed journal who had been involved in at least one of the previous regional audits. Repeat mailings were used to optimise the response rate.…”

“…Each involved approximately 2,000 patients across 10 to 13 units (Table 1). [9][10][11][12][13][14] The authors previously conducted a qualitative study with a small sample of healthcare professionals to evaluate this innovative regional audit programme. Findings from this work suggest that regional audit has specific strengths in the clinical governance armamentarium.…”