Background/Purpose: Urgent access for patients with rheumatic disease is limited in the United States, and it is often difficult to accommodate patients’ requests to be seen for urgent issues such as flare.  No reports of Rheumatologists with urgent care clinics (UCC) built into practices similar to primary care are available.  Currently many Rheumatologists use reserved slots in a provider’s schedule for urgent patients. This may be inadequate as these slots may be filled, particularly in academic practices which comprise providers who see patients only a few days per week, and may produce daily unpredictability in schedules. The primary objective of our study was to analyze a validated patient survey to determine a possible need to institute a dedicated UCC in our academic practice.

Methods: 390 patients were given validated surveys measuring access: Did you call for a concern that required urgent attention in the past 12 months? If so how often did you get an appointment as soon as you felt needed: Always Usually, Sometimes or Never. Patients in the Always group were compared with the group who marked Usually, Sometimes or Never. Confidence in the practice was measured using a visual analog scale (VAS): 0= not confident and 10= most confident. Patient demographic and primary diagnosis was collected. MDs were separated into those who provided clinical care 5 days per week and those who were available only 1-2 days weekly. Chi-square tests were used to compare categorical variables. Independent t-tests were used to compare continuous variables. A p-value of 0.05 was considered significant.

Results: 390 patients were surveyed, mean age 53.9, 83% female and 45% African Americans. 192 (49.2%) patients reported a need for urgent care in the past 12 months. 89 (46 %) felt they “always” were given a timely appointment (Adequate Access). 103 (53%) believed that they “usually”, “sometimes”, or “never” (Not Adequate Access) were given timely appointments to meet an urgent need. Mean available Confidence score for patients of 5 days providers (n=190) was 9.00 (1.76) compared with 8.26 (2.49) for non 5 day available providers (p=0.001). Mean Confidence scores for patients who did request an urgent appointment in past 12 months was 8.3 (2.50), compared with scores for patients who did not was 8.9 (1.82) (p=0.006) Table 1.

	5 Day Available Providers N=190	Non 5 Day Available Providers N=200	P-Value
Percentage of patient group who reported Not Adequate Access in obtaining urgent/timely appointment (N=103)	37.8 % (39)	62.1 % (64)	0.002
Mean confidence that future concerns will be addressed in a timely manner? (All patients)	9.0 (1.7)	8.2 (2.5)	0.002
Mean confidence that future concerns will be addressed in a timely manner among patients who had required urgent care in the last 12 months (N=191) Not Adequate Access group (n=102) Adequate Access group (n=89)	8.8 (2.0) 7.4 (2.4) 9.7 (0.9)	7.9 (2.8) 6.9 (2.9) 9.5 (1.3)	0.012 0.349 0.508
Mean confidence scores based on accessibility  Adequate Access group vs. Not Adequate Access group	9.6 (1.1) vs. 7.1 (2.8)		<0.001
Patients reporting: Always= Adequate access group; Usually, Sometimes or Never= Not-Adequate Access group. All values are in means and standard deviations unless specified

Conclusion: We observed an unmet need to provide urgent care access for patients with rheumatic diseases in our academic practice. This need is heightened especially in patients of providers with limited clinics in a week. Furthermore, mean confidence scores appear to be driven more by access than by the frequency that the provider practices clinically. A dedicated UCC might improve patient access and confidence in Rheumatology practices.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/overcoming-barriers-to-acute-patient-access-is-there-a-need-for-urgent-care-clinics-in-rheumatology-practices/