Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, V-Building, Room V2.09, Montreal, QC, Canada.
Rheumatol Int. 2010 Mar;30(5):705-7. doi: 10.1007/s00296-009-1297-5. Epub 2009 Dec 18.
It is important that inflammatory arthropathies such as rheumatoid arthritis be diagnosed promptly so that treatment can be administered in a timely fashion. However, there is considerable evidence that this process of care is delayed in many people. The aim of the study is to assess wait times between primary care referral and rheumatology assessment for new-onset inflammatory arthropathies. We performed a retrospective review related to new rheumatology consultations (N = 202) between September and November 2008 within the McGill University Health Centre, Montreal, Canada. At this centre, no formal triaging of rheumatology referrals exists. Of the 202 charts reviewed, wait times could be calculated in 164 cases. Only consultations for new-onset conditions were analyzed (N = 161). The results showed that patients with inflammatory arthritis were seen approximately 34.6 days (median 26) post-referral. Wait times for individuals who were ultimately diagnosed with non-urgent conditions (osteoarthritis, fibromyalgia and soft-tissue rheumatism) averaged 41.0 days (median 29). In conclusions, compared to non-urgent cases, individuals with inflammatory arthritis were seen about 1 week sooner. Nevertheless, provisional diagnosis provided on referrals did not appear to expedite wait times for persons with suspected inflammatory arthritis. This suggested that other factors, such as the concern of the patient, may have an influence on referral wait times. Implementation of a rapid access program or triage system may be helpful to further decrease wait times for inflammatory arthropathies.
重要的是，要及时诊断出炎性关节炎，如类风湿关节炎，以便及时进行治疗。然而，有大量证据表明，许多人在这个护理过程中被延误了。本研究的目的是评估新发病炎性关节炎患者从初级保健转诊到风湿病评估之间的等待时间。我们对 2008 年 9 月至 11 月期间在加拿大蒙特利尔麦吉尔大学健康中心新进行的风湿病咨询（N=202）进行了回顾性研究。在该中心，不存在风湿病转诊的正式分诊。在审查的 202 份图表中，有 164 份可以计算出等待时间。仅分析了新发病例的咨询（N=161）。结果表明，炎性关节炎患者在转诊后约 34.6 天（中位数 26）接受了检查。最终诊断为非紧急情况（骨关节炎、纤维肌痛和软组织风湿病）的患者的平均等待时间为 41.0 天（中位数 29）。总之，与非紧急病例相比，炎性关节炎患者的就诊时间提前了约 1 周。然而，在转诊时提供的临时诊断似乎并没有缩短疑似炎性关节炎患者的等待时间。这表明，其他因素，如患者的担忧，可能会对转诊的等待时间产生影响。实施快速通道计划或分诊系统可能有助于进一步缩短炎性关节炎的等待时间。
