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

Research output: Contribution to journalArticlepeer-review

Authors

  • Peter Nightingale
  • Clare Jinks
  • Sandy Herron-Marx
  • Rob Horne
  • Chris Deighton
  • Patrick Kiely
  • Christian Mallen

External organisations

  • Institute of Translational Medicine Birmingham (ITM)
  • Keele University

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.

Details

Original languageEnglish
Article number024361
JournalBMJ open
Volume9
Issue number3
Early online date4 Mar 2019
Publication statusE-pub ahead of print - 4 Mar 2019

Keywords

  • Access to care, Help-seeking, Patient delay, Primary care delay, Rheumatoid arthritis

ASJC Scopus subject areas