Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study. Issue 3 (4th March 2019)

• Record Type: Journal Article
• Authors: Stack, Rebecca Jayne; Nightingale, Peter; Jinks, Clare; Shaw, Karen; Herron-Marx, Sandy; Horne, Rob; Deighton, Chris; Kiely, Patrick; Mallen, Christian; Raza, Karim
• Other Names: author non-byline.; Asfaw Biruk author non-byline.; Kapoor Sabrina author non-byline.; Kumar Kanta author non-byline.; Slater Adam author non-byline.; Buckley Christopher author non-byline.; Booth Alison author non-byline.; Pradere Marie-josephe author non-byline.; Pande Ira author non-byline.; Gaywood Ian author non-byline.; Leone Francesca author non-byline.; Evans Bronwen author non-byline.; Bukhari Marwan author non-byline.; Taylor Julia author non-byline.; Knowles Helena author non-byline.; Westlake Sarah author non-byline.; Potter Tanya author non-byline.; Wilson Debbie author non-byline.; Smith Jayne author non-byline.; Walsh David author non-byline.; Ahwireng Nyarko author non-byline.; Aderonke Audu author non-byline.; Scott David author non-byline.; Nel Louise author non-byline.; Hare Naomi author non-byline.; Cope Andrew author non-byline.; Taylor Julie author non-byline.; Wilmott Wendy author non-byline.; Creamer Paul author non-byline.; Currie Lynn author non-byline.; Young Adam author non-byline.; Markwell Karen author non-byline.; Pollard Louise author non-byline.; Johnson Debbie author non-byline.; Allen Stephanie author non-byline.; Makadsi Raad author non-byline.; Prouse Peter author non-byline.; Cushnaghan Janet author non-byline.; Sabu Jessy author non-byline.; Arumugam Moorthy author non-byline.; Bridges Matt author non-byline.; Race Pam author non-byline.; Symonds Dawn author non-byline.; Bridges Matt author non-byline.; Cobb Jackie author non-byline.; Filer Andrew author non-byline.; Bowman Simon author non-byline.; Jobanputra Paresh author non-byline.; Edwards Julie author non-byline.; Sheeran Tom author non-byline.; Crowley Caroline author non-byline.; Jassim Imad author non-byline.; Gray Julie author non-byline.; Packham Jon author non-byline.; Allcoat Paul author non-byline.; Harris Helen author non-byline.; Rowland Rebecca author non-byline.; Knights Sally author non-byline.; Heslop Peta author non-byline.; Robinson Sandra author non-byline.; Walker David author non-byline.; Russell Heather author non-byline.; Mitchell Sheryl author non-byline.; Cripps Heather author non-byline.; Fairburn Kevin author non-byline.; Cotterell Sue author non-byline.; Welch Gillian author non-byline.; Madan Ayesha author non-byline.; The Lee Suan author non-byline.; Winstanley Lucy author non-byline.; Bhagat Shweta author non-byline.; Kadiki Lucy author non-byline.; Ramful Chitra author non-byline.; Sandhu Ravinder author non-byline.; Datson Amanda author non-byline.; Woolf Anthony author non-byline.;
• Is Part Of: BMJ open. Volume 9:Issue 3(2019)
• Publication Date: 2019-03-04
• Subjects: rheumatoid arthritis -- patient delay -- primary care delay -- help-seeking -- access to care; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-024361
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: To investigate delays from symptom onset to rheumatology assessment for patients with a new onset of rheumatoid arthritis (RA) or unclassified arthritis. Methods: Newly presenting adults with either RA or unclassified arthritis were recruited from rheumatology clinics. Data on the length of time between symptom onset and first seeing a GP (patient delay), between first seeing a general practitioner (GP) and being referred to a rheumatologist (general practitioner delay) and being seen by a rheumatologist following referral (hospital delay) were captured. Results: 822 patients participated (563 female, mean age 55 years). The median time between symptom onset and seeing a rheumatologist was 27.2 weeks (IQR 14.1–66 weeks); only 20% of patients were seen within the first 3 months following symptom onset. The median patient delay was 5.4 weeks (IQR 1.4–26.3 weeks). Patients who purchased over-the-counter medications or used ice/heat packs took longer to seek help than those who did not. In addition, those with a palindromic or an insidious symptom onset delayed for longer than those with a non-palindromic or acute onset. The median general practitioner delay was 6.9 weeks (IQR 2.3–20.3 weeks). Patients made a mean of 4 GP visits before being referred. The median hospital delay was 4.7 weeks (IQR 2.9–7.5 weeks). Conclusion: This study identified delays at all levels in the pathway towards assessment by a rheumatologist. However, delays in primary care were particularly long. Patient delay was driven by the nature of symptom onset. Complex multi-faceted interventions to promote rapid help seeking and to facilitate prompt onward referral from primary care should be developed.