Background The national audit office reported variation in the quality of services for patients with Inflammatory Arthritis (IA) in the UK in 2009. The Health Quality Improvement Partnership funded a national audit to explore this further.
Objectives We set out to assesses whether trusts in England & Wales are achieving the 7 quality standards (QS) published by the National Institute for Health & Care Excellence (NICE).
Methods All individuals >16 years presenting to specialist rheumatology services in England & Wales with suspected new onset IA were recruited. Clinician & patient derived data were collected against all NICE QS over the 1st 3 months of specialist care.
Results 6,354 patients were recruited nationally from 1 February 2014 to 31 January 2015. 94% of trusts/health submitted data. Patients were predominantly female (66%); white British (79%); and of working age (70%). At recruitment 46% had a diagnosis of Rheumatoid Arthritis (RA); 16% undifferentiated inflammatory arthritis (EIA).
Only 17% of patients were referred by their general practitioner (GP) within 3 days of first presentation (QS1); median time interval 34 days. Over 25% waited >3 months. 12% of referrals had no indication that EIA was suspected.
Specialist assessment occurred <3 weeks of referral for 38% (QS2). The median time interval was 4 weeks, >25% of patients waited >7 weeks. Higher staffing levels (>1 consultant/100,000 population) & the presence of EIA clinics were associated with shorter waiting times (odds ratio (95%CI) 1.3 (1.1–1.4) & 1.6 (1.4–1.7) respectively).
Disease modifying anti-rheumatic drug (DMARD) initiation within 6 weeks of referral (QS3) was achieved in 53% of RA patients; 36% were treated with combination DMARDs & 82% with steroids.
Clinicians reported that 59% of patients received structured education (QS4). Treat to target plans were set for 91% of patients. These targets were achieved in only 27% (QS5). Almost all trusts reported access to urgent advice (QS6) & incorporated annual review services (QS7).
Conclusions This audit has enabled English & Welsh rheumatology services to measure their performance against NICE QS for the early management of IA & RA, benchmarked to regional & national comparators for the first time. The findings clearly demonstrate where improvement is needed. Delays in referral from primary care as well as delays in offering a first appointment in secondary care have been identified as key barriers to effective early arthritis care.
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.