title: Early referral to the rheumatologist for early arthritis patients: evidence for suboptimal care. Results from the ESPOIR cohort.
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.
authors.affiliation: Department of Rheumatology, Pitié-Salpétriêre Hospital, 83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France. bruno.fautrel@psl.aphp.fr
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.forename: Mathilde
authors.initials: M
authors.lastname: Benhamou
authors.forename: Violaine
authors.initials: V
authors.lastname: Foltz
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rincheval
authors.forename: Anne-Christine
authors.initials: AC
authors.lastname: Rat
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
authors.forename: Francis
authors.initials: F
authors.lastname: Berenbaum
authors.forename: Pierre
authors.initials: P
authors.lastname: Bourgeois
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000628:therapy; D002983:Clinical Competence; D042241:Early Diagnosis; D004812:Epidemiologic Methods; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005602:France; D019983:Guideline Adherence; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D013997:Time Factors; D055815:Young Adult