title: Time to consultation and disease-modifying antirheumatic drug treatment of patients with rheumatoid arthritis--northern Alberta perspective.
abstract: OBJECTIVE
  To determine the timeliness of consultation and initiation of disease-modifying antirheumatic drugs (DMARD) in patients with rheumatoid arthritis (RA) referred to rheumatologists.
  
  
  METHODS
  The first part of the study was a review of the charts of 151 patients with RA followed by 3 rheumatologists. The outcome measure was the interval between symptom onset and consultation with a rheumatologist. The second part of the study involved a chart review of 4 family physician practices in a small urban center in order to determine the accuracy of diagnostic coding (International Classification of Diseases; ICD-9) of RA, as well as the proportion of patients with RA seen by a rheumatologist. Finally, a survey was sent to primary care physicians at a group of walk-in clinics to determine what percentage of their patients with RA were referred to a rheumatologist and, concerning referral patterns, how likely it is they would refer a confirmed or suspected RA patient to a rheumatologist.
  
  
  RESULTS
  Patients with RA referred to rheumatologists in this sample were seen by a rheumatologist at a mean of 9.8 months (median 5 mo, range 0-129 mo) after symptom onset, and mean 1.2 months (median 4.0 mo, range 0-8 mo) after being referred by their primary care physician. All referred patients with confirmed RA were started on DMARD within 1 week of initial consultation. Primary care physicians would refer suspected RA patients 99.5% of the time (median 100, range 90-100%), and 87.6% (median 90, range 50-100%) of patients with confirmed RA would have seen a rheumatologist at least once. A chart review showed that, in a select group of family physicians, 70.9% (22/31) of patients coded as RA per the ICD-9 did indeed have RA and all had seen a rheumatologist for their condition.
  
  
  CONCLUSIONS
  In Northern Alberta, patients with RA are seen and started on DMARD therapy in a timely fashion. Most of the delay is at the primary care level, suggesting a need for improved education of patients and primary care physicians rather than a formal triage system.
authors.affiliation: Department of Medicine, 13-103 Clinical Sciences Building, University of Alberta, 11350 - 83 Avenue, Edmonton, Alberta T6G 2P4, Canada.
authors.forename: Jalal A
authors.initials: JA
authors.lastname: Nanji
authors.forename: May
authors.initials: M
authors.lastname: Choi
authors.forename: Robert
authors.initials: R
authors.lastname: Ferrari
authors.forename: Christopher
authors.initials: C
authors.lastname: Lyddell
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Russell
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000639:trends; D012017:Referral and Consultation / Q000639:trends*; D012189:Retrospective Studies; D012219:Rheumatology / Q000639:trends*; D019035:Rural Health Services / Q000639:trends*
chemical_list: D018501:Antirheumatic Agents