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Abstract Number: 1031

Quantifying the Delays to Rheumatologist Consultation and Treatment Among Patients with Systemic Inflammatory Rheumatic Diseases

Jessica Widdifield1, Sasha Bernatsky2, J Carter Thorne3, Claire Bombardier4, R. Liisa Jaakkimainen5, Vandana Ahluwalia6, J. Michael Paterson7, Noah Ivers4, Debra Butt8 and Karen Tu8, 1McGill University, Montreal, QC, Canada, 2Rheum/Clin. Epid., McGill MUHC/RVH, Montreal, QC, Canada, 3Southlake Regional Health Centre, Newmarket, ON, Canada, 4University of Toronto, Toronto, ON, Canada, 5Preventive Med and Biostatisti, University of Toronto, Toronto, ON, Canada, 6Past President, Ontario Rheumatology Association, Brampton, ON, Canada, 7ICES, Toronto, ON, Canada, 8Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Access to care and quality measures

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Session Information

Date: Sunday, November 8, 2015

Session Title: Quality Measures and Quality of Care

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Optimal care for systemic inflammatory rheumatic diseases often hinges upon early referral from primary care physicians (PCP) to rheumatologists. Our aim was to quantify the time from symptom onset (T0) to 1st PCP visit related to the complaint (T1) to PCP referral to rheumatologist (T2) to 1st rheumatologist visit (T3), and to treatment (T4).

Methods: We employed a novel approach to identify 1st-time rheumatology referrals from the primary care Electronic Medical Record Administrative data Linked Database (EMRALD), representing comprehensive EMR data from 168 PCPs across Ontario, Canada (32 rural, 39 suburban and 97 urban physicians). Using a standardized data abstraction tool, PCP and rheumatology consultation records were reviewed to identify diagnoses and treatments associated with each referral. Administrative data were used to identify accurate dates of the 1st rheumatologist visit subsequent to the date of referral identified in the EMR. The time in days from the date of each component of the care pathway was determined overall and for each diagnostic category.

Results: Among 2430 patients with 1st-time referrals, we identified 745 patients with systemic inflammatory rheumatic diseases (31%): RA (16%), other inflammatory arthritis (22%), connective tissue diseases (18%), gout/crystal arthropathies (16%), spondyloarthropathies (10%), psoriatic arthritis (6%), polymyalgia rheumatica (9%), and vasculitis (3%). Overall, 21% and 70% of patients were seen by rheumatologists within 3 months of symptom onset and PCP referral, respectively. Wait-time measures varied by condition (table). Comparing to established Canadian wait-time measures (target being 100%), only 38% of RA patients were seen within 4 weeks from the date of referral, 63% of AS/SpA patients were seen within 3 months; and 34% of PsA patients were seen within 6 weeks. For RA patients, the median time to be seen by rheumatologists from symptom onset and referral was 327 and 66 days, respectively.  Within the 1st year, 93% of RA patients had a documented treatment initiated by a rheumatologist, and of these, 95% were prescribed DMARDs, 26% oral steroid, 15% steroid injection, and 6% biologic. The average time to DMARD was 56 days from date of first rheumatology consultation.

Conclusion: Our representative sample of PCPs revealed longer wait-times than previous reports that sampled patients from urban rheumatology clinics and exceed current Canadian recommendations. Most of the delay occurs prior to referral, where targeted efforts are needed to optimize care for more timely consultations.   

Table.

Proportion of Patients seen by

rheumatologists within

RA

n=120

IA

n=167

Crystal

n=122

PMR

n=66

AS/SpA

n=76

PsA

n=44

Vasculitis n=19

CTDs/Other n=131

1 mo. from

Referral

38%

35%

27%

47%

22%

25%

53%

27%

Symptom onset

#

#

5%

#

#

#

#

#

3 mo. from

Referral

71%

70%

64%

71%

63%

59%

74%

62%

Symptom onset

24%

21%

16%

28%

14%

#

28%

17%

6 mo. from

Referral

79%

80%

83%

82%

83%

86%

74%

76%

Symptom onset

42%

46%

35%

53%

34%

34%

39%

30%

9 mo. from

Referral

84%

83%

88%

86%

86%

96%

79%

77%

Symptom onset

50%

59%

45%

63%

39%

43%

44%

42%

12 mo. from

Referral

87%

86%

89%

88%

86%

98%

79%

82%

Symptom onset

59%

66%

47%

72%

41%

49%

56%

47%

Median (IQR) Time

(in days)

Symptom onset (T0) to

PCP (T1)

173

(16-189)

102

(10-112)

188

(4-192)

63

(14-77)

716

(14-730)

228

(17-245)

128

(3-131)

208

(14-222)

PCP visit (T1) to

Referral (T2)

115

(14-128)

125

(11-136)

353

(20-373)

123

(15-138)

173

(7-181)

513

(15-528)

73

(7-80)

181

(7-188)

Symptom onset (T0) to

Referral (T2)

326

(49-375)

259

(41-300)

1326

(48-1374)

238

(55-293)

1342

(63-1405)

627

(90-7167)

293

(33-325)

855

(44-899)

Referral (T2) to

Rheumatologist (T3)

66

(15-81)

55

(17-71)

69

(24-93)

53

(11-64)

62

(29-91)

88

(30-117)

28

(11-39)

62

(22-83)

Symptom onset (T0) to

Rheumatologist (T3)

327

(83-410)

260

(91-350)

1312

(111-1423)

240

(81-321)

1262

(112-1374)

680

(125-805)

608

(59-667)

940

(113-1053)

Abbreviations: RA: Rheumatoid Arthritis; IA: Inflammatory Arthritis – other (e.g., undifferentiated); Crystal: Gout and other crystal arthropathies; PMR: Polymyalgia Rheumatica; AS/SpA: Ankylosing Spondylitis and other spondyloarthropathies; PsA: Psoriatic Arthritis; CTDs: Connective Tissue Diseases and other systemic autoimmune rheumatic diseases (e.g., lupus, scleroderma, SjogrenÕs, RaynaudÕs); IQR: interquartile range; # not reported due low count


Disclosure: J. Widdifield, None; S. Bernatsky, None; J. C. Thorne, None; C. Bombardier, None; R. L. Jaakkimainen, None; V. Ahluwalia, None; J. M. Paterson, None; N. Ivers, None; D. Butt, None; K. Tu, None.

To cite this abstract in AMA style:

Widdifield J, Bernatsky S, Thorne JC, Bombardier C, Jaakkimainen RL, Ahluwalia V, Paterson JM, Ivers N, Butt D, Tu K. Quantifying the Delays to Rheumatologist Consultation and Treatment Among Patients with Systemic Inflammatory Rheumatic Diseases [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/quantifying-the-delays-to-rheumatologist-consultation-and-treatment-among-patients-with-systemic-inflammatory-rheumatic-diseases/. Accessed January 27, 2023.
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