The Effect of Triage Assessments on Identifying Inflammatory Arthritis and Reducing Rheumatology Wait Times in Ontario

Claire Bombardier¹, Sydney Brooks², Mary Bell³, Angela Cesta⁴, Tetyana Kendzerskaya⁵, Raquel Sweezie⁶, Jessica Widdifield⁷, Laura Fullerton⁸, Vandana Ahluwalia⁹ and Arthur Karasik¹⁰, ¹Toronto General Hospital Research Institute, Toronto, ON, Canada, ²The Arthritis Society, Toronto, ON, Canada, ³University of Toronto, Toronto, ON, Canada, ⁴Ontario Best Practices Research Initiative, University Health Network, Toronto, ON, Canada, ⁵Institute for Clinical Evaluative Studies, Toronto, ON, Canada, ⁶Arthritis Rehabilitation and Education Program, The Arthritis Society, Toronto, ON, Canada, ⁷McGill University, Montreal, QC, Canada, ⁸Division of Support, Systems and Outcomes, University Health Network, Toronto, ON, Canada, ⁹Ontario Rheumatology Association, Brampton, ON, Canada, ¹⁰Ontario Rheumatology Association, Toronto, ON, Canada

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Access to care, inflammatory arthritis, occupational therapy and physical therapy, Triage

Session Information

Date: Sunday, November 13, 2016

Title: Health Services Research - ARHP Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Excessive delays to rheumatologists have been documented and triage assessments of suspected IA referrals from primary care may be a key strategy to expedite access to rheumatologists. We evaluated the positive and negative predictive values (PPV and NPV) of triage assessments by extended role practitioners (ERP) for identifying patients with IA. We also estimated the time from primary care referral to rheumatology consultation, comparing those patients who were expedited by an ERP (suspected IA) versus those who were not.

Methods: Patients with possible IA were identified from rheumatologists’ wait lists through a paper triage process. Patients were included if they were adults and newly referred by a general practitioner or nurse practitioner within the previous month. An ERP established a weekly triage clinic in each participating rheumatologist’s office and assessed each patient using a standardized tool to identify patients for an expedited rheumatologist consult. Non-expedited patients went back on the waiting list to receive the next available routine appointment. Patients were then followed for three months post referral with dates of rheumatologist consultations and clinical diagnoses identified by chart review. We determined the proportion of patients correctly triaged by ERPs for expedited access. The median (interquartile range) time from primary care referral to the first rheumatologist consultation was determined, comparing patients who were prioritized for an expedited assessment versus those who were not, and compared to the provincial average (median: 66 days)*.

Results: Six rheumatologists agreed to participate in the study. Of 317 patients identified from the rheumatologists’ wait lists as having possible IA, 177(56%) met inclusion criteria and received an ERP triage assessment (female: 67%; mean age (SD): 53 (14)). Of these, 75/177 patients (42%) were prioritized by the therapist for an expedited appointment with the rheumatologist. For expedited patients, 71/75(95%) were seen by the rheumatologist within 3 months of referral and the median (IQR) time from referral to rheumatologist consultation was 37 (24.3-54.8) days. Upon consultation, the rheumatologist suspected IA or connective tissue disease (CTD) in 58/71(PPV=0.817). Among those not prioritized**, 68/101 patients (67%) were seen by the rheumatologist within three months of referral and the median (IQR) time from referral to rheumatologist visit was 100 (68.3-131.5) days. Of those, 13/68 received a differential diagnosis of IA/CTD (NPV=0.809).

Conclusion: Triage by an ACPAC trained ERP resulted in a high number of patients with suspected IA/CTD being correctly prioritized for a rheumatology consultation. For prioritized patients, the wait time was less than the provincial median. These results suggest that an ERP working in a triage role can improve access to rheumatology care for patients with suspected IA. *Widdifield et al. “Patterns of care among first-time referrals to rheumatologists: Characteristics and timeliness of consultations and treatment in Ontario, Canada” Arthritis Care & Research 2016; Apr 25. doi:10.1002/acr.22910. **1 patient missing

Disclosure: C. Bombardier, None; S. Brooks, None; M. Bell, None; A. Cesta, None; T. Kendzerskaya, None; R. Sweezie, None; J. Widdifield, None; L. Fullerton, None; V. Ahluwalia, None; A. Karasik, None.

To cite this abstract in AMA style:

Bombardier C, Brooks S, Bell M, Cesta A, Kendzerskaya T, Sweezie R, Widdifield J, Fullerton L, Ahluwalia V, Karasik A. The Effect of Triage Assessments on Identifying Inflammatory Arthritis and Reducing Rheumatology Wait Times in Ontario [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-effect-of-triage-assessments-on-identifying-inflammatory-arthritis-and-reducing-rheumatology-wait-times-in-ontario/. Accessed .

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