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Rheumatology Advance Access published online on November 23, 2009
Rheumatology, doi:10.1093/rheumatology/kep340
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Early referral to the rheumatologist for early arthritis patients: evidence for suboptimal care. Results from the ESPOIR cohort

Bruno Fautrel1,2, Mathilde Benhamou1,2, Violaine Foltz1,2, Nathalie Rincheval3, Anne-Christine Rat4,5, Bernard Combe6, Francis Berenbaum7,8, Pierre Bourgeois1,2 and Francis Guillemin4,5

1APHP, Groupe Hospitalier Pitié-Salpêtrière, Service de Rhumatologie, 2Université Pierre et Marie Curie – Paris VI, UFR de médecine, Paris, 3Université Montpellier 1, UFR de Médecine, Institut Universitaire de Recherche Clinique, Montpellier, 4Nancy Université, EA 4360 APEMAC, Ecole de Santé Publique, Faculté de Médecine de Nancy, 5INSERM, CHU de Nancy, CIC-EC Centre D’épidémiologie Clinique, Nancy, 6Centre Hospitalo-Universitaire du Montpellier, Hôpital Lapeyronie, Service de Rhumatologie, Montpellier, 7APHP, Hôpital Saint Antoine, Service de Rhumatologie and 8Université Pierre et Marie Curie – Paris VI, UFR de médecine, Paris, France.

Correspondence to: Bruno Fautrel, Department of Rheumatology, Pitié-Salpétriêre Hospital, 83 Boulevard de l’Hôpital, 75651 Paris Cedex 13, France. E-mail: bruno.fautrel{at}psl.aphp.fr


  Abstract

Objective. To assess the time to access a rheumatologist (TTAR) by early arthritis (EA) patients participating in a nationwide incidental cohort (ESPOIR) and compare it with European League Against Rheumatism (EULAR) recommendations, which recommends rapid referral, ideally within 6 weeks, to a rheumatologist for patients presenting with EA.

Methods. Eight hundred and thirteen patients with EA were included in the cohort between 2002 and 2005. The inclusion criteria were 18–70 years old, two or more swollen joints, symptom duration from 6 weeks to 6 months and possible RA diagnosis. TTAR was defined as the time between the first synovitis and first visit to a rheumatologist. TTAR and satisfaction of the EULAR guidelines were investigated by multiple linear and logistic regressions.

Results. Mean TTAR was 76 days; only 46.2% of patients were seen by a rheumatologist within the EULAR-recommended time frame. Patients’ patterns of accessing medical care substantially affected access to specialized care: mean TTAR was 58 days for patients who directly scheduled an appointment with the rheumatologist and 78 days for those referred by their general practitioner (P < 0.0007). Only 57.2 and 44.5%, respectively, were able to consult a rheumatologist within 6 weeks. Multivariate analysis confirmed the significant impact of indirect access on TTAR, after adjustment for EA characteristics and medical density in the region.

Conclusions. Significant disparities were identified in the care of EA patients in terms of early access to a rheumatologist. More effort is needed to optimize the physicians’ knowledge about EA and to improve the efficiency of medical networks.

KEY WORDS: Rheumatoid arthritis, Disease management, Health service research, Clinical practice guidelines, Managed care

Submitted 22 May 2009; revised version accepted 22 September 2009.
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