Among the many patients with Rheumatic and Musculoskeletal Diseases (RMDs) who can and should be appropriately diagnosed and treated by General Practitioners or Orthopaedic Specialists, a substantial minority requires Rheumatologists and their special expertise. This expertise is frequently not readily accessible due to limited availability of Rheumatologists, limited knowledge concerning RMDs on the side of both patients and physicians, or geographic obstacles. Therefore, delays in diagnosis and treatment by far exceed the threshold considered harmless.
Our approach to shorten these delays was to establish an immediate access clinic (IAC) in our large University Department. This IAC offers “low threshold” access for patients and their physicians to specialist assessment, recommendations, and care. Analysis of the outcomes of this IAC approach demonstrated that less than 45% of the patients were considered to need specialists’ diagnosis/care at time of presentation. A typical assessment in the IAC usually lasts less than 10 minutes, nevertheless, follow-up after 6-12 months showed that >75% of the diagnoses of inflammatory rheumatic diseases initially suspected at the IAC proved to be correct. Over 60% of patients who in the opinion of the Rheumatologist did not require specialty care stated that their problems had fully resolved at follow-up. Despite the easy access offered by this clinic, only a minority of patients (21.5%) presented with symptoms of less than three months.
In conclusion, the reliability of recommendations given in the IAC appears to be high, with the main advantage of virtually complete elimination of waiting times. Our approach may serve as a model for improving access to Rheumatologic care without loss of quality.
Disclosure of Interest None Declared