Early referral and assessment by rheumatology services is vital in preventing disability. However, for the first time, this British Society for Rheumatology (BSR) report shows that many patients in England and Wales are experiencing long waiting times, which fall outside of the recommended guidelines and standards developed by the National Institute for Clinical Excellence.
The report identifies that although most services offer prompt educational support and agree targets for treatment with their patients, only one quarter of services achieve the agreed targets within 3 months of follow-up.
Key findings include:
- 1 in 6 patients were referred by their GP to rheumatology services within 3 days, (NICE Quality Standard 1); one quarter of patients, however, waited more than 3 months to be referred
- 38% of patients were seen by rheumatology services within 3 weeks of referral (NICE Quality Standard 2)
- More than half of patients were treated with disease modifying drugs within 6 weeks, irrespective of whether they were seen within 3 weeks of referral (NICE Quality Standard 3).
Clinical Audit Director, Dr Jo Ledingham said:
"Inflammatory arthritis, and in particular rheumatoid arthritis, is a common cause of disability in adults and can reduce life expectancy. Early initiation and rapid escalation of disease modifying treatments can prevent disability and reduce long term complications, but rapid access to specialist services is needed to facilitate this as part of a care package in partnership with the patient."
The national clinical audit for rheumatoid and early inflammatory arthritis uses data from 6,354 patients collected from 143 trusts and health boards, representing almost all NHS rheumatology providers in England and Wales. The report examines the assessment and early secondary care management of all forms of peripheral joint early inflammatory arthritis.
Commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcome Programme (NCAPOP), the report was delivered by the British Society for Rheumatology, Northgate Public Services and the MRC Lifecourse Epidemiology Unit, based at the University of Southampton.
Recommendations from the BSR report include:
- Training and support should be given to primary care in order to raise awareness of the early symptoms and signs of inflammatory arthritis and importance of early referral.
- Rheumatology services and providers should assess how to increase clinical capacity, ensuring quicker access to rheumatologists and building suitable care packages in partnership with patients.
- The NHS should develop better systems for capturing, coding, and integrating outpatient information from clinics, including measures of patient experience and outcome.
Dr Ledingham added:
"This complex audit - collecting information from individual patients at multiple time points and within busy clinic settings - has been a huge challenge for rheumatology departments. We would like to acknowledge the contribution of clinicians in recruiting patients and providing the high quality data that have underpinned the analysis. The audit results provide crucial information on service provision and can facilitate negotiations with employers and commissioners to improve services for patients."
Further, following their participating in the audit, a number of trusts and health boards have informed us they have already successfully reconfigured their services in order to improve patient care. Data from the 2nd year of the audit, which will be published in due course, should quantify these changes in more detail."
A clinician report and a patient report were published today at a BSR event at The Kings Fund in central London. Both reports can be downloaded at http://www.rheumatology.org.uk/resources/audits/national_ra_audit/annual_report.aspx
Data collection for the BSR National Clinical Audit for inflammatory and rheumatoid arthritis began on 1 February 2014 and will continue for 3 years.
The audit examines the assessment and early secondary care management of all forms of peripheral joint early inflammatory arthritis (EIA) in all NHS secondary care settings in England and Wales.
Detailed follow up and outcome data is collected, up to three months from recruitment, on the subgroup of patients presenting with rheumatoid pattern EIA. The NICE quality standards for the management of RA are the key standards being assessed, which link with the Best Practice Tariff.