Chilton Frances, Bradley Eleanor, Mitchell Theresa
Rheumatology Department, Warwick Hospital NHS Foundation Trust, Warwick, Warwickshire, UK.
Division of Health Psychology, College of Life, Health and Environmental Sciences, Worcester University, Worcester, Worcestershire, UK.
Musculoskeletal Care. 2021 Dec;19(4):495-503. doi: 10.1002/msc.1546. Epub 2021 Mar 15.
Early referral forms a crucial part in early inflammatory/rheumatoid arthritis (EI/RA) recovery. Delayed decisions to refer can lead to severe incapacity and emotional distress for individuals and family and feelings of lost time. How patients with EI/RA experience early referral decisions in Primary Care is an under explored area and warrants further investigation.
To explore how patients newly diagnosed with EI/RA experienced their early contacts with Primary Care as they negotiated their journey through the referral process into secondary care.
Qualitative face-to-face interviews with newly diagnosed EI/RA patients.
In-depth semi-structured interviews were conducted to explore patients' experiences of referral from first symptoms to General Practitioner referral. All participants were interviewed within 2 weeks of being diagnosed in Secondary Care. Data analysis was conducted using interpretative phenomenological analysis.
All participants in this study described having experienced struggles with their navigation through Primary Care towards diagnosis and specialist EI/RA services. This struggle comprised five key elements: 'family persuasion', 'lack of continuity in care', 'pushing for referral', 'strained relations' and 'lost time'.
The delays experienced by patients when attempting to reach an early referral decision in Primary Care cause frustration for those presenting with EI/RA, partly because they do not feel heard. There is a significant impact on patients and their families when referral to specialist care is delayed.
早期转诊是早期炎症性/类风湿性关节炎（EI/RA）康复的关键环节。转诊决定的延迟可能导致患者及其家人出现严重的身体残疾和情绪困扰，以及时间被浪费的感觉。EI/RA患者在初级医疗保健中如何经历早期转诊决定是一个尚未充分探索的领域，值得进一步研究。
探讨新诊断为EI/RA的患者在通过转诊流程进入二级医疗保健的过程中，如何体验他们与初级医疗保健的早期接触。
对新诊断为EI/RA的患者进行定性面对面访谈。
进行深入的半结构化访谈，以探讨患者从首次出现症状到全科医生转诊的转诊经历。所有参与者均在二级医疗保健机构确诊后的2周内接受访谈。采用解释性现象学分析进行数据分析。
本研究中的所有参与者都描述了在通过初级医疗保健机构进行诊断和获得专业EI/RA服务的过程中遇到的困难。这种困难包括五个关键因素：“家人劝说”、“护理缺乏连续性”、“催促转诊”、“关系紧张”和“时间浪费”。
患者在初级医疗保健机构试图做出早期转诊决定时所经历的延迟，给EI/RA患者带来了挫折感，部分原因是他们觉得自己的意见未被听取。转诊至专科护理的延迟对患者及其家人有重大影响。
