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BMJ Open. 2019 Mar 4;9(3):e024361. doi: 10.1136/bmjopen-2018-024361.

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

Author information

1
Division of Psychology, Nottingham Trent University, Nottingham, UK.
2
Wellcome Trust Clinical Research Facility, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
3
Arthritis Research UK Primary Care Centre, Keele University, Keele, UK.
4
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
5
Independent Research Consultant, Brussels, Belgium.
6
UCL School of Pharmacy, UCL, London, UK.
7
Department of Rheumatology, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK.
8
Department of Rheumatology, St Georges University Hospital NHS Foundation Trust, London, UK.
9
Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
10
Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.

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.

KEYWORDS:

access to care; help-seeking; patient delay; primary care delay; rheumatoid arthritis

PMID:
30837252
DOI:
10.1136/bmjopen-2018-024361
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Conflict of interest statement

Competing interests: None declared.

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