Background/Purpose: Urgent care clinics are built into some primary care practices, but no reports are available of urgent care clinics in rheumatology settings.  Many rheumatologists currently reserve slots in their schedules to accommodate patients with urgent needs.  However, this practice may be inadequate as the slots may become filled by waitlisted, follow-up, or new patients, particularly in academic practices where providers may see patients only a few days per week.  A survey of patients with rheumatic diseases indicated that 50% reported inadequate provider access for urgent concerns, which was greater among patients of providers whose clinical activities involved fewer rather than 5 days per week.  We studied patients seen at an academic rheumatology urgent care clinic to analyze possible reduction in emergency room (ER) visits, and possible improved patient confidence that timely care by their rheumatologist is available.

Methods: A weekly urgent care clinic was initiated for established patients under care at an academic rheumatology setting who had issues that could not wait until their next appointment, as well as for recently discharged inpatients with need of early outpatient follow up.  A control group of 100 patients seen sequentially in routine care was identified, and compared to the urgent care group using t tests and chi square tests.  Each patient in the control and urgent care group completed a multidimensional health assessment questionnaire (MDHAQ) at each visit as part of routine care, with scores for physical function, pain, patient global assessment, RAPID3  (routine assessment of patient index data), and demographic data.  Each physician scored a contemporaneous physician global assessment.  An additional survey for urgent care clinic patients queried if patients would have gone to the ER if not seen today (Yes or No) and the level of the patients’ confidence that future urgent concerns would be met (0=no confidence – 10=great confidence).

Results: Demographics of the 42 patients and 100 controls are in Table 1. Those seen in the urgent care clinic were older, less likely to work full time, and more likely to have osteoarthritis than the controls.  MDHAQ scores were significantly higher in the urgent care clinic vs controls (Table 1).  61% of urgent care patients reported that they would have gone to the ER if the urgent care clinic were not available, and mean confidence score of patients in the urgent care clinic group was 9.75 on a 0-10 scale.

	Control Group N=100	Urgent Care Group N=42	P
Female, n (%)	81 (81.0%)	34 (80.9%)	0.99
Age, mean (SD)	51.8 (16.8)	59.9 (15.8)	0.01
Ethnicity, n (%) Caucasian Afro-American Hispanic Others	– 48 (48%) 36 (36%) 8 (8%) 8 (8%)	– 13 (31.7%) 22 (53%) 5 (12.2%) 2 (3.1%)	– 0.11
Education, mean (SD)	14.6 (2.9)	14.1 (2.7)	0.45
Work Full time, n (%)	34 (40%)	5 (19%)	0.05
Diagnosis, n (%): RA OA SLE Crystal Diseases Other Diseases	– 29 (29%) 9 (9%) 16 (16%) 3 (3%) 43 (43%)	– 9 (21.9%) 10 (24.4%) 2 (4.8%) 5 (5.7%) 16 (43.2%)	– 0.037
Physician Global (0-10), mean (SD)	3.6 (2.2)	5.4 (1.0)	<0.001
Patient Global (0-10) , mean (SD)	4.3 (2.9)	7.2 (1.6)	<0.001
PAIN (0-10) , mean (SD)	4.6 (3.3)	7.3 (2.2)	<0.001
FUNCTION (0-10) , mean (SD)	2.3 (2.2)	4.5 (2.9)	<0.001
RAPID3 (0-30) , mean (SD)	10.9 (7.4)	17.7 (4.3)	<0.001
Anxiety (0-3.3)	0.57 (0.77)	0.91 (0.16)	0.03
Depression (0-3.3)	0.44 (0.73)	0.82 (0.97)	0.018

All scores are mean (standard deviation=SD)

Conclusion: Patients seen in the urgent care clinic had poorer clinical status than control patients, with higher patient and physician scores.  61% would have gone to the ER had they not been seen in the urgent care clinic.  These patients also expressed high confidence that timely access would be available in the future. Improved patient access for urgent needs may be met by a dedicated urgent care clinic.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-access-to-health-care-in-rheumatology-practices-through-initiation-of-an-outpatient-urgent-care-clinic-a-paradigm-shift/