Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study

Stack, R.J. ORCID: 0000-0002-0516-0228, Nightingale, P., Jinks, C., Shaw, K., Herron-Marx, S., Horne, R., Deighton, C., Kiely, P., Mallen, C. and Raza, K., 2019. Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study. BMJ Open, 9 (3): e024361. ISSN 2044-6055

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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 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.

Item Type: Journal article
Publication Title: BMJ Open
Creators: Stack, R.J., Nightingale, P., Jinks, C., Shaw, K., Herron-Marx, S., Horne, R., Deighton, C., Kiely, P., Mallen, C. and Raza, K.
Publisher: BMJ Group
Date: February 2019
Volume: 9
Number: 3
ISSN: 2044-6055
Identifiers:
NumberType
10.1136/bmjopen-2018-024361DOI
Divisions: Schools > School of Social Sciences
Depositing User: Jonathan Gallacher
Date Added: 18 Dec 2018 15:14
Last Modified: 27 Mar 2019 14:49
URI: http://irep.ntu.ac.uk/id/eprint/35376

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