title: The influence of ethnicity on the extent of, and reasons underlying, delay in general practitioner consultation in patients with RA.
abstract: OBJECTIVE
  Delay in assessment by rheumatologists of patients with new-onset RA is an important determinant of delay in treatment initiation. The influence of ethnicity on delay in assessment has not been addressed. We studied the extent of delay in patients of South Asian origin compared with other patients and the reasons underlying this delay.
  
  
  METHODS
  Data were collected from 272 patients with RA at the time of assessment by a rheumatologist; 43 were of South Asian origin. Delays were recorded at the level of the patient seeking advice from the general practitioner (GP), the GP referring to secondary care and the rheumatologist seeing the patient after the referral had been made. In addition, using qualitative methods, we assessed the reasons underlying delay in help-seeking behaviour in 10 patients of South Asian origin.
  
  
  RESULTS
  Patient delay was significantly longer in patients of South Asian origin than in other patients. Delays at the level of primary and secondary care were not different. Four interlinking themes influenced how rapidly early RA patients of South Asian origin consulted their GPs: symptom experience, symptom evaluation, existing ideas, and knowledge of RA and influence of friends and family.
  
  
  CONCLUSIONS
  Patient-dependent factors leading to delays in GP consultation, are the principal reason for the considerable delay in RA patients of South Asian origin being seen by rheumatologists. An understanding of the reasons underlying this delay will inform the development of interventions to reduce it in this population.
authors.affiliation: Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, UK. k.raza@bham.ac.uk
authors.forename: Kanta
authors.initials: K
authors.lastname: Kumar
authors.forename: Enid
authors.initials: E
authors.lastname: Daley
authors.forename: Fazal
authors.initials: F
authors.lastname: Khattak
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Buckley
authors.forename: Karim
authors.initials: K
authors.lastname: Raza
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology; D044466:Asian People / Q000523:psychology*; D001294:Attitude to Health; D003142:Communication; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D013997:Time Factors; D006113:United Kingdom