title: Immediate access rheumatology clinic: efficiency and outcomes.
abstract: OBJECTIVE
  In order to facilitate access and shorten waiting times to rheumatologist assessment, an immediate access clinic (IAC) was established. Patients were assessed at presentation in the clinic and after 6-12 months, either in the clinic or by telephone. Data regarding diagnostic accuracy, pain levels and care were analysed.
  
  
  RESULTS
  From February to December 2009, 1036 patients were assessed. 223 (21.5%) patients had symptoms for 3 months or less. 660 were available for re-assessment after 6-12 months. Initial tentative diagnoses were confirmed in over 75% of patients suspected of having rheumatoid arthritis (RA), spondylarthropathy and osteoarthritis. Men suspected of having spondylarthropathy had a significantly longer symptom duration than women (median (IQR) 54.0 (18.0-120.0) vs 24.0 (6.0-66.0) months; p=0.0082). There was no significant gender difference regarding pain. At follow-up, the visual analogue scale for pain in RA patients admitted to further care in the clinic (n=61) had significantly decreased by a median (IQR) of 37.5 mm (10.5-50.5), whereas this improvement was only 6 mm (-26-33.5) in the 22 RA patients followed outside the clinic (p=0.0083).
  
  
  CONCLUSIONS
  The IAC resulted in considerable waiting time reduction for rheumatology assessment. A substantial minority was seen before 3 months' symptom duration. 'Positive predictive correctness' of the assessing rheumatologists regarding the presence of inflammatory rheumatic conditions was over 75%. Patients with RA cared for in the clinic had substantially lower pain levels after 6-12 months' follow-up than patients treated elsewhere.
authors: Department of Rheumatology, Medical University of Vienna, Vienna, Austria.
authors: Miriam
authors: M
authors: Gärtner
authors: Julia P
authors: JP
authors: Fabrizii
authors: Elisabeth
authors: E
authors: Koban
authors: Martin
authors: M
authors: Holbik
authors: Lorenz P
authors: LP
authors: Machold
authors: Josef S
authors: JS
authors: Smolen
authors: Klaus P
authors: KP
authors: Machold
mesh_terms: D000328:Adult; D000368:Aged; D001317:Austria; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010146:Pain / Q000209:etiology; D010147:Pain Measurement / Q000379:methods; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012216:Rheumatic Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D012219:Rheumatology / Q000458:organization & administration*; D012737:Sex Factors; D013997:Time Factors; D014850:Waiting Lists