Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study
Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study
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DOI：
10.1136/bmjopen-2018-024361
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Woolf, Anthony
中科院分区：
文献类型：
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作者：
Stack, Rebecca Jayne;Nightingale, Peter;Woolf, Anthony
目的 调查新发类风湿性关节炎 (RA) 或未分类关节炎患者从症状出现到进行风湿病学评估的延迟情况。方法从风湿病诊所招募新出现 RA 或未分类关节炎的成人。收集了从症状出现到第一次看全科医生（患者延迟）之间、从第一次看全科医生 (GP) 到被转诊至风湿病专家（全科医生延迟）和转诊后由风湿病专家看诊（医院延迟）之间的时间长度的数据。 结果 822 名患者参与（563 名女性，平均年龄 55 岁）。症状出现和就诊风湿病专家之间的中位时间为 27.2 周（IQR 14.1-66 周）；只有 20% 的患者在症状出现后的前 3 个月内就诊。患者中位延误时间为 5.4 周（IQR 1.4-26.3 周）。购买非处方药或使用冰袋/热袋的患者比没有购买非处方药或使用冰袋/热袋的患者寻求帮助的时间更长。此外，具有回文或隐匿症状的患者比具有非回文或急性症状的患者延迟更长的时间。全科医生延迟中位时间为 6.9 周（IQR 2.3-20.3 周）。患者在转诊前平均拜访了 4 次全科医生。中位住院延误时间为 4.7 周（IQR 2.9-7.5 周）。 结论 这项研究确定了风湿病专家评估途径中各个级别的延误情况。然而，初级保健的延误时间特别长。患者延迟是由症状发作的性质引起的。应制定复杂的多方面干预措施，以促进快速寻求帮助并促进初级保健的迅速转诊。
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.