A systematic literature review of strategies promoting early referral and reducing delays in the diagnosis and management of inflammatory arthritis
Annals of Rheumatic Diseases,  Evidence Based Medicine  Clinical Article

Villeneuve E et al. – This review identified three main areas of delay to care for patients with inflammatory arthritis (IA) and potential solutions for each. A co–ordinated effort will be required by the rheumatology and primary care community to address these effectively.

Methods
  • The authors searched literature published between January 1985 and November 2010, and ACR and EULAR s between 2007–2010.
  • Additional information was obtained through a grey literature search, a survey conducted through ACR and EULAR, and a hand search of the literature.

Results
  • (1) From symptom onset to primary care, community case–finding strategies, including the use of a questionnaire and autoantibody testing, have been designed to identify patients with early IA.
  • Several websites provided information on IA but were of varying quality and insufficient to aid early referral.
  • (2) At a primary care level, education programmes and patient self–administered questionnaires identified patients with potential IA for referral to rheumatology.
  • Many guidelines emphasised the need for early referral with one providing specific referral criteria.
  • (3) Once referred, early arthritis clinics provided a point of early access for rheumatology assessment.
  • Triage systems, including triage clinics, helped prioritise clinic appointments for patients with IA.
  • Use of referral forms standardised information required, further optimising the triage process. Wait times for patients with acute IA were also reduced with development of rapid access systems.

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