AB1010 Achievement of Nice Quality Standards for Patients with New Presentation of Inflammatory Arthritis: Results from The Uk National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

Autor: Ali Rivett, Elizabeth MacPhie, Zoe Ide, Elaine M. Dennison, Neil Snowden, Jill Firth, Joanna M. Ledingham, James Galloway, Ian A. Rowe, Ngianga Ii Kandala
Rok vydání: 2016
Předmět:
Zdroj: Annals of the Rheumatic Diseases. 75:1247.1-1247
ISSN: 1468-2060
0003-4967
DOI: 10.1136/annrheumdis-2016-eular.4584
Popis: 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 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
Databáze: OpenAIRE