Background The time between symptom onset and treatment initiation is determined by patient-, disease- and physician-related factors but also by differences in healthcare organization and referral pathways across various countries.
Objectives To explore the importance of the type of rheumatology practice on the duration of different types of delay.
Methods 156 DMARD naive early RA patients were included from eight practices across Flanders: 1 academic hospital, 5 general hospitals and 2 private practices. 8 different types of delay were defined from symptom onset untill treatment initiation. Information on the duration of each stage of delay was collected from the patients, their general practitioner (GP) and patient files at the practice. Patient/GP demographics and disease activity/severity parameters were registered.
Results Median total delay in Flemish private rheumatology practices was shorter compared to academic and general hospitals(p<0,001). Total delay was significantly different between an academic hospital and a private practice (p<0,001). However, only patient delay from all the different sub-stages of delay between symptom onset and treatment, was longer, albeit at borderline significance (p= 0,051). A general hospital displayed a significantly longer patient delay according to the GP, but also a more important total rheumatologist delay and total delay compared to a private practice (p=0,041, p=0,025 and p=0,005). In absolute numbers, patient delay can be seen as the cause of longer delays in academic and general hospitals compared to private practices. At treatment initiation, the physician global assessment score was higher in patients from private practices (p=0,022) compared to the other two settings. The total tender joint count and presence of comorbidities was higher in patients from academic hospitals (p= 0,032 and p=0,023) compared to the other two settings. In general hospitals, less patients with the presence of ACPA and less patients suffering from morning stiffness (p=0,005 and p=0,016) were seen compared to the other two settings.
Conclusions The type of rheumatology center seems a pivotal determinant of treatment delay in Flanders.
Disclosure of Interest None Declared
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