Document Detail

Time to treatment in rheumatoid arthritis: factors associated with time to treatment initiation and urgent triage assessment of general practitioner referrals.
MedLine Citation:
PMID:  20689443     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The importance of early diagnosis and treatment of rheumatoid arthritis (RA) is increasingly being recognized. This requires accurate triaging of suspected RA referrals from primary care and expedient assessment of these patients in secondary care.
OBJECTIVES: To assess the factors associated with urgent triage for first specialist appointment and early disease modifying agents in rheumatic disease treatment.
METHODS: The general practitioner (GP) referrals to a single rheumatology service from 128 new RA patients were assessed for their information content and triage allocation by the Rheumatologists. Information on symptoms, signs, and investigation results were collected. Factors associated with urgent triage allocation, time to treatment, and a GP requesting urgency were assessed.
RESULTS: Median time from symptom onset to treatment was 6.1 months. Triage allocation to urgent was associated with earlier treatment (difference of 97 days, P = 0.003). GP perception of urgency (odds ratio = 13.34, 95% confidence interval: 2.20-81.02) was independently associated with an urgent triage allocation by the triaging rheumatologist. Swollen joints and a raised C-reactive protein predicted GP request for urgency.
CONCLUSION: Triage is important to facilitate early treatment; however, rheumatologists in this service are not currently triaging suspected RA referrals with reference to known poor prognostic indicators. Several interventions could improve both informative referrals and triaging of referrals to decrease time to diagnosis and treatment. These interventions could include public education, GP education sessions with associated distribution of referral guidelines, and reminding triaging rheumatology clinicians about the available prognostic factors often present in GP referrals that assist with correct triage.
Philip C Robinson; William J Taylor
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases     Volume:  16     ISSN:  1536-7355     ISO Abbreviation:  J Clin Rheumatol     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-02     Completed Date:  2010-12-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9518034     Medline TA:  J Clin Rheumatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  267-73     Citation Subset:  IM    
Rheumatology Department, Hutt Hospital, Wellington, New Zealand.
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MeSH Terms
Antirheumatic Agents / therapeutic use
Arthritis, Rheumatoid / blood,  drug therapy*,  physiopathology*
C-Reactive Protein / metabolism
General Practitioners* / education
Guidelines as Topic
Joints / physiopathology
Middle Aged
New Zealand
Referral and Consultation*
Retrospective Studies
Time Factors
Reg. No./Substance:
0/Antirheumatic Agents; 9007-41-4/C-Reactive Protein

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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