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Explore This IssueSeptember 2014
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Delay in seeing a rheumatologist and getting treatment for rheumatic diseases can make a huge difference in outcomes, and experts at the Annual European Congress of Rheumatology (EULAR 2014) in June discussed ways to speed up the process.
Hastening access to care is a problem that has been studied in the U.S., and an American College of Rheumatology/European League Against Rheumatism joint task force has also explored the problem. In the session, the experts discussed ways to improve the connection between general practitioners (GPs) and rheumatologists, tactics to shorten the delay at four different steps in the path to treatment and the reasons patients wait before seeing a doctor.
Christian Mallen, MD, a GP and professor of general practice research at Keele University in the United Kingdom, said primary care physicians need to be able to exercise better judgment in making referrals to rheumatologists. But when it comes down to it, the symptoms for which patients go to a GP can often overlap symptoms in rheumatic diseases, although very few of those patients will actually end up having a rheumatic disease.
Musculoskeletal problems, for example, are top reasons patients see a primary care provider, but only a small portion need to be seen by a rheumatologist. Back pain is a common symptom, Dr. Mallen said, but most GPs will come across one ankylosing spondylitis patient every two or three years, he said.
“The symptoms are common, but pathology is rare in general practice,” Dr. Mallen said. “As such, it’s very challenging for the GP to untangle this to get the right person to rheumatology.” He often feels like he’s “trying to find the needle in the haystack.”
An approach that might be worthwhile is for patients to be fast-tracked for “red flag” symptoms. He said he has seen good results from rheumatologists seeing patients along with GPs. Another good practice is giving patients clear, detailed discharge plans, with a clear management plan and descriptions of the roles of a patient’s various providers, Dr. Mallen said.
GPs have an important role in the care of rheumatic patients even after they’re referred to a specialist—by helping treat comorbidities and helping patients navigate work and benefits issues, he said. Plus, they can help coordinate care that often ends up involving many specialists, he said.
“Coordinating that takes time, it takes knowledge,” he said. “And I think primary care probably is the best place for that to be happening.”
Options for Shortening Delay
There are a lot of options for shortening delays in patients getting access to rheumatologists and to the therapies they need, but some are more worthwhile than others, said Bruno Fautrel, MD, PhD, professor of rheumatology at Pitié Salpêtrière Hospital in Paris.