Immediate access rheumatology clinic: efficiency and outcomes.

OBJECTIVE AND METHODS

In order to facilitate access and shorten waiting times to rheumatologist assessment, an immediate access clinic (IAC) was established. Patients were assessed at presentation in the clinic and after 6-12 months, either in the clinic or by telephone. Data regarding diagnostic accuracy, pain levels and care were analysed.

RESULTS

From February to December 2009, 1036 patients were assessed. 223 (21.5%) patients had symptoms for 3 months or less. 660 were available for re-assessment after 6-12 months. Initial tentative diagnoses were confirmed in over 75% of patients suspected of having rheumatoid arthritis (RA), spondylarthropathy and osteoarthritis. Men suspected of having spondylarthropathy had a significantly longer symptom duration than women (median (IQR) 54.0 (18.0-120.0) vs 24.0 (6.0-66.0) months; p=0.0082). There was no significant gender difference regarding pain. At follow-up, the visual analogue scale for pain in RA patients admitted to further care in the clinic (n=61) had significantly decreased by a median (IQR) of 37.5 mm (10.5-50.5), whereas this improvement was only 6 mm (-26-33.5) in the 22 RA patients followed outside the clinic (p=0.0083).

CONCLUSIONS

The IAC resulted in considerable waiting time reduction for rheumatology assessment. A substantial minority was seen before 3 months' symptom duration. 'Positive predictive correctness' of the assessing rheumatologists regarding the presence of inflammatory rheumatic conditions was over 75%. Patients with RA cared for in the clinic had substantially lower pain levels after 6-12 months' follow-up than patients treated elsewhere.