229 The impact of the EIA clinic on early RA care

Yates, Mark; Galloway, James; Snowden, Neil; Norton, Sam; Macgregor, Alexander J; Rivett, Ali; Souto, Miguel; Dennison, Elaine M; Hider, Sam L; Ledingham, Joanne M

Abstract

Background: Trials indicate early intervention and tight disease control in rheumatoid arthritis (RA) associate with improved outcomes. This is reflected in the NICE quality statements for early RA care, and in the Best Practice Tariff for RA. Many service providers have adopted a dedicated early inflammatory arthritis (EIA) clinic to meet national guidance. Uptake of this model is not universal and its impact has not been studied in the real world setting. The aim of this analysis was to assess the impact of an EIA clinic service model on performance, using the National Clinical Audit (NCA) of EIA.

Methods: The NCA was conducted to assess early RA care. All NHS providers in England and Wales were required to participate. Follow up data were captured over three months. Trust and patient level variables were collected. Patients with a confirmed diagnosis of inflammatory arthritis were included. The mean times from first presentation with symptoms to rheumatology referral (referral time), and from receipt of referral to first rheumatology clinic visit (rheumatology clinic review time) for each Trust were calculated. The analysis assessed the relationship between the presence of an EIA clinic and referral times. We also examined potential confounding influences of Trust and patient level characteristics through regression modelling.

Results: Of 146 eligible Trusts, 137 provided data. 7340 patients were diagnosed with inflammatory arthritis. 7313 were seen at Trusts that provided EIA clinic information. 77/137 (56%) Trusts offered an EIA clinic, and had significantly shorter referral and rheumatology clinic review times (see table). This was maintained after adjustment. Considering case-mix, only deprivation as measured by index of multiple deprivation (IMD) differed between centres (higher average deprivation in centres with no EIA clinic).Tender and swollen joint count at diagnosis didn't correlate with referral time.

Conclusion: Access to EIA clinics varies nationally. The presence of an EIA service correlates with reduced delays both in primary and secondary care. Previous work from the NCA has shown that timely rheumatology review associates with improved outcomes. This supports the value of a dedicated early arthritis service model. The factors that constitute a successful EIA clinic require further characterisation.

Citation

Yates, M., Galloway, J., Snowden, N., Norton, S., Macgregor, A. J., Rivett, A., …Ledingham, J. M. (2018). 229 The impact of the EIA clinic on early RA care. Rheumatology, 57(suppl_3), https://doi.org/10.1093/rheumatology/key075.453

• Journal Article Type: Conference Paper
• Conference Name: British Society for Rheumatology Annual Conference 2018
• Online Publication Date: Apr 25, 2018
• Publication Date: Apr 1, 2018
• Deposit Date: Jun 28, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 57
• Issue: suppl_3
• DOI: https://doi.org/10.1093/rheumatology/key075.453
• Keywords: Pharmacology (medical); Rheumatology