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Extended report
Immediate access rheumatology clinic: efficiency and outcomes
  1. Miriam Gärtner1,
  2. Julia P Fabrizii1,
  3. Elisabeth Koban1,
  4. Martin Holbik2,
  5. Lorenz P Machold1,
  6. Josef S Smolen1,
  7. Klaus P Machold1
  1. 1Department of Rheumatology, Medical University of Vienna, Vienna, Austria
  2. 2Department of Pharmacy, University of Vienna, Vienna, Austria
  1. Correspondence to Klaus P Machold, MD, Department of Rheumatology, Medical University of Vienna, Währinger Gürtel 18–20, A-1090 Vienna, Austria; klaus.machold{at}


Objective and Methods In order to facilitate access and shorten waiting times to rheumatologist assessment, an immediate access clinic (IAC) was established. Patients were assessed at presentation in the clinic and after 6–12 months, either in the clinic or by telephone. Data regarding diagnostic accuracy, pain levels and care were analysed.

Results From February to December 2009, 1036 patients were assessed. 223 (21.5%) patients had symptoms for 3 months or less. 660 were available for re-assessment after 6–12 months. Initial tentative diagnoses were confirmed in over 75% of patients suspected of having rheumatoid arthritis (RA), spondylarthropathy and osteoarthritis. Men suspected of having spondylarthropathy had a significantly longer symptom duration than women (median (IQR) 54.0 (18.0–120.0) vs 24.0 (6.0–66.0) months; p=0.0082). There was no significant gender difference regarding pain. At follow-up, the visual analogue scale for pain in RA patients admitted to further care in the clinic (n=61) had significantly decreased by a median (IQR) of 37.5 mm (10.5–50.5), whereas this improvement was only 6 mm (−26–33.5) in the 22 RA patients followed outside the clinic (p=0.0083).

Conclusions The IAC resulted in considerable waiting time reduction for rheumatology assessment. A substantial minority was seen before 3 months' symptom duration. ‘Positive predictive correctness’ of the assessing rheumatologists regarding the presence of inflammatory rheumatic conditions was over 75%. Patients with RA cared for in the clinic had substantially lower pain levels after 6–12 months' follow-up than patients treated elsewhere.

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Ethics Committee of the Medical University of Vienna.

  • Provenance and peer review Not commissioned; externally peer reviewed.