Quick-Access Clinic Improves Rheumatology Care

An immediate access clinic significantly reduced the wait times for patients seeking rheumatology assessments, based on data from 660 patients seen between February and December 2009. The findings were published in the March issue of Annals of the Rheumatic Diseases.

"The delay from symptom onset to the first visit with a rheumatologist or start of therapy ranges from several months up to more than 1 year," said Dr. Miriam Gärtner of the Medical University of Vienna and her colleagues.

One reason for the delay in care is the lack of rheumatologists, the researchers said. To help get patients started on therapy sooner, an immediate access clinic (IAC) was established, in which patients could be seen within 1 day to 2 weeks of their referral, or seen immediately for a brief evaluation without a referral.

Of 1,036 patients who were assessed in the clinic during the study period, 660 patients were reevaluated 6-12 months after visiting the clinic. The patients were divided into those who were referred for further care in the clinic (331 patients) and those referred for further care outside of the clinic (329 patients). The average age of the patients was 50 years, and the average duration of symptoms was 24 years; the average pain rating on the visual analog scale of 0-100 mm was 54 mm (Ann. Rheum. Dis. 2012;71:363-8).

At a 6- to 12-month follow-up visit, 75% of the initial diagnoses that had been made at the clinic proved to be correct, the researchers said. "This indicates high reliability of these initial categorizations by an experienced rheumatologist, which often have to be made within only a few minutes, compared with a later and mostly ‘criteria-based’ classification," they said.

Of the patients who were referred for follow-up in the clinic, 213 returned for additional care and 118 did not return. Overall, 90% of those who returned for additional care received treatment depending on their diagnoses, with 25%-73% receiving disease-modifying antirheumatic drugs, 1%-25% receiving biologics, *5%-56% receiving glucocorticoids, and 2%-17% receiving physiotherapy. Of those who did not return for additional care (but were contacted later by phone), 38% said they received additional therapy at their initial visit. Of these, 42% received NSAIDs, 16% received biologics, 13% received synthetic DMARDs or physiotherapy, and 4% received glucocorticoids.

Of the 329 who were reached for follow-up after 6-12 months, 60% reported that their medical problems were "fully resolved," whereas approximately 40% said they were receiving additional medical care.

Approximately one-third of the patients were referred to the clinic because of suspected RA, but their median symptom duration of 9 months was beyond the ideal window of opportunity for effective early treatment (which should be within the first 3 months), the researchers noted.

Men were diagnosed with spondyloarthropathy more often than women, whereas women were more often diagnosed with osteoarthritis.

Also, "no difference in the frequency of final diagnosis of an inflammatory rheumatic disease between physician and self-referred individuals was apparent," the researchers said.

The study findings were limited by the potential unreliability of telephone interviews. But the results suggest that the IAC model is effective for reducing wait times for seeing a rheumatologist, and that the majority of the diagnoses made in this setting were accurate, the researchers said.

"Despite the short time of interaction between patient and rheumatologist at the time of the visit to the IAC, complaints about insufficient attention were very rare," the researchers added. "Apparently, patients appreciated the fact that they had an immediate opportunity to discuss their problems with a specialist, albeit for a short time, and to receive an initial diagnostic assessment and therapeutic recommendations," they said.

Dr. Gärtner and colleagues had no financial conflicts to disclose.

* Correction, 3/2/2012: An earlier version of this story incorrectly reported the percentages of returning patients who received glucocorticoids.

An immediate access clinic significantly reduced the wait times for patients seeking rheumatology assessments, based on data from 660 patients seen between February and December 2009. The findings were published in the March issue of Annals of the Rheumatic Diseases.

"The delay from symptom onset to the first visit with a rheumatologist or start of therapy ranges from several months up to more than 1 year," said Dr. Miriam Gärtner of the Medical University of Vienna and her colleagues.

One reason for the delay in care is the lack of rheumatologists, the researchers said. To help get patients started on therapy sooner, an immediate access clinic (IAC) was established, in which patients could be seen within 1 day to 2 weeks of their referral, or seen immediately for a brief evaluation without a referral.

Of 1,036 patients who were assessed in the clinic during the study period, 660 patients were reevaluated 6-12 months after visiting the clinic. The patients were divided into those who were referred for further care in the clinic (331 patients) and those referred for further care outside of the clinic (329 patients). The average age of the patients was 50 years, and the average duration of symptoms was 24 years; the average pain rating on the visual analog scale of 0-100 mm was 54 mm (Ann. Rheum. Dis. 2012;71:363-8).

At a 6- to 12-month follow-up visit, 75% of the initial diagnoses that had been made at the clinic proved to be correct, the researchers said. "This indicates high reliability of these initial categorizations by an experienced rheumatologist, which often have to be made within only a few minutes, compared with a later and mostly ‘criteria-based’ classification," they said.

Of the patients who were referred for follow-up in the clinic, 213 returned for additional care and 118 did not return. Overall, 90% of those who returned for additional care received treatment depending on their diagnoses, with 25%-73% receiving disease-modifying antirheumatic drugs, 1%-25% receiving biologics, *5%-56% receiving glucocorticoids, and 2%-17% receiving physiotherapy. Of those who did not return for additional care (but were contacted later by phone), 38% said they received additional therapy at their initial visit. Of these, 42% received NSAIDs, 16% received biologics, 13% received synthetic DMARDs or physiotherapy, and 4% received glucocorticoids.

Of the 329 who were reached for follow-up after 6-12 months, 60% reported that their medical problems were "fully resolved," whereas approximately 40% said they were receiving additional medical care.

Approximately one-third of the patients were referred to the clinic because of suspected RA, but their median symptom duration of 9 months was beyond the ideal window of opportunity for effective early treatment (which should be within the first 3 months), the researchers noted.

Men were diagnosed with spondyloarthropathy more often than women, whereas women were more often diagnosed with osteoarthritis.

Also, "no difference in the frequency of final diagnosis of an inflammatory rheumatic disease between physician and self-referred individuals was apparent," the researchers said.

The study findings were limited by the potential unreliability of telephone interviews. But the results suggest that the IAC model is effective for reducing wait times for seeing a rheumatologist, and that the majority of the diagnoses made in this setting were accurate, the researchers said.

"Despite the short time of interaction between patient and rheumatologist at the time of the visit to the IAC, complaints about insufficient attention were very rare," the researchers added. "Apparently, patients appreciated the fact that they had an immediate opportunity to discuss their problems with a specialist, albeit for a short time, and to receive an initial diagnostic assessment and therapeutic recommendations," they said.

Dr. Gärtner and colleagues had no financial conflicts to disclose.

* Correction, 3/2/2012: An earlier version of this story incorrectly reported the percentages of returning patients who received glucocorticoids.

An immediate access clinic significantly reduced the wait times for patients seeking rheumatology assessments, based on data from 660 patients seen between February and December 2009. The findings were published in the March issue of Annals of the Rheumatic Diseases.

"The delay from symptom onset to the first visit with a rheumatologist or start of therapy ranges from several months up to more than 1 year," said Dr. Miriam Gärtner of the Medical University of Vienna and her colleagues.

One reason for the delay in care is the lack of rheumatologists, the researchers said. To help get patients started on therapy sooner, an immediate access clinic (IAC) was established, in which patients could be seen within 1 day to 2 weeks of their referral, or seen immediately for a brief evaluation without a referral.

Of 1,036 patients who were assessed in the clinic during the study period, 660 patients were reevaluated 6-12 months after visiting the clinic. The patients were divided into those who were referred for further care in the clinic (331 patients) and those referred for further care outside of the clinic (329 patients). The average age of the patients was 50 years, and the average duration of symptoms was 24 years; the average pain rating on the visual analog scale of 0-100 mm was 54 mm (Ann. Rheum. Dis. 2012;71:363-8).

At a 6- to 12-month follow-up visit, 75% of the initial diagnoses that had been made at the clinic proved to be correct, the researchers said. "This indicates high reliability of these initial categorizations by an experienced rheumatologist, which often have to be made within only a few minutes, compared with a later and mostly ‘criteria-based’ classification," they said.

Of the patients who were referred for follow-up in the clinic, 213 returned for additional care and 118 did not return. Overall, 90% of those who returned for additional care received treatment depending on their diagnoses, with 25%-73% receiving disease-modifying antirheumatic drugs, 1%-25% receiving biologics, *5%-56% receiving glucocorticoids, and 2%-17% receiving physiotherapy. Of those who did not return for additional care (but were contacted later by phone), 38% said they received additional therapy at their initial visit. Of these, 42% received NSAIDs, 16% received biologics, 13% received synthetic DMARDs or physiotherapy, and 4% received glucocorticoids.

Of the 329 who were reached for follow-up after 6-12 months, 60% reported that their medical problems were "fully resolved," whereas approximately 40% said they were receiving additional medical care.

Approximately one-third of the patients were referred to the clinic because of suspected RA, but their median symptom duration of 9 months was beyond the ideal window of opportunity for effective early treatment (which should be within the first 3 months), the researchers noted.

Men were diagnosed with spondyloarthropathy more often than women, whereas women were more often diagnosed with osteoarthritis.

Also, "no difference in the frequency of final diagnosis of an inflammatory rheumatic disease between physician and self-referred individuals was apparent," the researchers said.

The study findings were limited by the potential unreliability of telephone interviews. But the results suggest that the IAC model is effective for reducing wait times for seeing a rheumatologist, and that the majority of the diagnoses made in this setting were accurate, the researchers said.

"Despite the short time of interaction between patient and rheumatologist at the time of the visit to the IAC, complaints about insufficient attention were very rare," the researchers added. "Apparently, patients appreciated the fact that they had an immediate opportunity to discuss their problems with a specialist, albeit for a short time, and to receive an initial diagnostic assessment and therapeutic recommendations," they said.

Dr. Gärtner and colleagues had no financial conflicts to disclose.

* Correction, 3/2/2012: An earlier version of this story incorrectly reported the percentages of returning patients who received glucocorticoids.