Delay in consultation with specialists for persons with suspected new‐onset rheumatoid arthritis: A population‐based study

Abstract

Objective. Care in rheumatoid arthritis (RA) is optimized by involvement of rheumatologists. We wished to determine whether patients suspected of having new-onset RA in Québec consulted with a rheumatologist, to document any delay in these consultations, and to determine factors associated with prompt consultation. Methods. Physician reimbursement administrative data were obtained for all adults in Québec. Suspected new-onset cases of RA in the year 2000 were defined operationally as a physician visit for RA (based on the International Classification of Diseases, Ninth Revision diagnostic codes), where there had been no prior visit code to any physician for RA in the preceding 3 years. For those patients who were first diagnosed by a nonrheumatologist, Cox regression modeling was used to identify patient and physician characteristics associated with time to consultation with a rheumatologist. Results. Of the 10,001 persons coded as incident RA by a nonrheumatologist, only 27.3% consulted a rheumatologist within the next 2.5-3.5 years. Of those who consulted, the median time from initial visit to a physician for RA to consultation with a rheumatologist was 79 days. The strongest predictors of shorter time to consultation were female sex, younger age, being in a higher socioeconomic class, and having greater comorbidity. Conclusion. Our data suggest that the vast majority of patients suspected of having new-onset RA do not receive rheumatology care. Further action should focus on this issue so that outcomes in RA may be optimized.

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

“…They speculated further that limited access to rheumatoid arthritis related specialist care contributes to the under-treatment of rheumatoid arthritis in Ontario and perceived long waiting times have a deterrent effect on referrals by general and family practitioners. A recent Canadian study by Feldman and colleagues 51 found that the majority of patients in Quebec suspected of having new-onset rheumatoid arthritis do not receive rheumatology care.…”

Proposal for an Urgency Score as General Referral Strategy to Second- Care Rheumatology

“…Out of these 23.5% (n = 36) had a maximal symptom presentation in the morning, 12.4% (n = 19) at night and 15.0% (n = 19) both in the morning and at night.…”

The specific features of diagnosis of rheumatoid arthritis in real clinical practice

“…Так, в Канаде в реальной кли-нической практике только 27% из 10 тыс. пациентов с по-дозрением на РА, зарегистрированных у врачей общей практики, попадают на консультацию к ревматологам [10]. В Великобритании время, которое проходит с момен-та обращения больного РА к врачу общей практики до на-правления к ревматологу, увеличилось за последние годы с …”

“…Такими навыками не-достаточно владеют терапевты, педиатры и врачи амбула-торной практики [6,7]. В Канаде, Великобритании и США проведен ряд исследований, показавших, что врачи общей практики оказывают больным РА недостаточно ка-чественную помощь, а студенты и интерны имеют недос-таточный уровень подготовки по проблемам ревматоло-гии, что связано с дефицитом учебных часов при вузов-ском образовании [8][9][10]. Так, в Канаде в реальной кли-нической практике только 27% из 10 тыс.…”

“…Это вызывает крайнюю озабоченность специалистов-ревмато-логов и позволяет им говорить о низком качестве меди-цинского обслуживания больных с РЗ на этапе консульта-ций у врачей общей практики [9,10,13]. В России в результате проведенного исследования было показано, что основной причиной поздней постанов-ки диагноза РА является задержка пациента на амбулатор-но-поликлиническом этапе у терапевта и ненаправление его к ревматологу.…”