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

Bruno Fautrel 1 Mathilde Benhamou 2 Violaine Foltz 2 Nathalie Rincheval 3 Anne-Christine Rat 4, 5 Bernard Combe 6 Francis Berenbaum Pierre Bourgeois 2 Francis Guillemin 4, 5 Alain Saraux 7, 8, 9
1 Rhumatologie
2 Service de Rhumatologie [CHU Pitié-Salpêtrière]
3 Centre de coordination
4 APEMAC - Maladies chroniques, santé perçue, et processus d'adaptation
5 Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy
6 IGMM - Institut de Génétique Moléculaire de Montpellier
7 EA2216 - Immunologie et Pathologie
8 CHU - BREST - Rhumato - CHRU Brest - Service de Rhumatologie
9 CIC - Brest - Centre d'Investigation Clinique
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.
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Article dans une revue
Rheumatology, Oxford University Press (OUP), 2010, 49 (1), pp.147-55. 〈10.1093/rheumatology/kep340〉
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Contributeur : Ghislaine Calvez <>
Soumis le : mardi 19 février 2013 - 16:33:09
Dernière modification le : mardi 24 juillet 2018 - 10:16:01

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UNIV-BREST | CGE | UNIV-PARIS5 | IMMUNO | UNIV-LORRAINE | USPC | BS | UNIV-MONTPELLIER | APEMAC-UL

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Bruno Fautrel, Mathilde Benhamou, Violaine Foltz, Nathalie Rincheval, Anne-Christine Rat, et al.. Early referral to the rheumatologist for early arthritis patients: evidence for suboptimal care. Results from the ESPOIR cohort.. Rheumatology, Oxford University Press (OUP), 2010, 49 (1), pp.147-55. 〈10.1093/rheumatology/kep340〉. 〈hal-00790224〉

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