Prioritization Tool for RA Referrals Improves Access

VBCR - December 2014, Volume 3, No 6 - In the Literature

Results from a recent prospective analysis indicated that the use of a prioritization tool for rheumatoid arthritis (RA) referrals improves access when rheumatologists are scarce (Cummins L, et al. Arthritis Care Res (Hoboken). 2014 Aug 22. Epub ahead of print).

Over the course of 8 months, investigators evaluated new adult rheumatology referrals with possible inflammatory arthritis to determine whether the 2010 American College of Rheumatology (ACR)/European League Against Rheumatology (EULAR) Classification Criteria for RA improved triage decisions and reduced waiting times. Data concerning rheumatologist diagnosis, use of disease-modifying antirheumatic drugs (DMARDs), and waiting times were also collected.

Approximately 450 referrals were screened: 180 met criteria for inclusion, 143 provided sufficient data after information was requested, and 71 referrals met triage criteria. Forty percent of the 63 patients who attended their appointments received diagnoses of RA by a rheumatologist. Mean wait times were 7.9 weeks for referrals who fulfilled triage criteria and 45.4 weeks for referrals who did not meet triage criteria. The sensitivity and specificity of the diagnostic tool were 96% and 56%, respectively. In addition, the positive predictive value was 40%, whereas the negative predictive value was 98%.

Cummins and colleagues found that implementing the 2010 ACR/EULAR Classification Criteria for RA as a prioritization tool could improve the wait time of patients diagnosed with RA. “Waiting time was reduced for RA patients,” they concluded. “Applying this strategy in areas of rheumatology scarcity may permit earlier DMARD treatment.”

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