title: Development of a Multidimensional Additive Points System for Determining Access to Rheumatology Services.
abstract: OBJECTIVE
  In many countries, including New Zealand, the demand for rheumatology services exceeds their supply, resulting in some patients experiencing long delays or being denied access. The principal aim of this work was to create a validated, transparent, and fair system for determining access to rheumatology services.
  
  
  METHODS
  A panel of 5 rheumatologists, 6 primary care physicians, and 4 nurse specialists ranked a series of 25 clinical scenarios in order of priority to see a rheumatologist. Important determining factors were weighted in an iterative process to generate a multidimensional additive point score to determine access to rheumatology service.
  
  
  RESULTS
  The score comprises 6 domains of 2 to 4 items weighted to give a total score out of 100. The effect of the problem on the patient's life and role, the presence of an inflammatory rheumatic disease, appropriateness of current treatment, and the ability of the rheumatologist to influence the current symptoms and future prognosis were felt to be critical factors in determining access to the service. The score showed a strong correlation with the rankings agreed by the clinical panel, and the overall intraclass correlation coefficient for the rheumatologists was 0.698.
  
  
  CONCLUSIONS
  Our score has face validity, is easy to perform, and has been assessed by an independent panel of rheumatologists as providing a fair system for determining access to rheumatology services. The system is acceptable to primary care physicians and has been adopted by our local primary care organizations.
authors.affiliation: From the *Rheumatology Department, Waikato Hospital, Hamilton; †Waikato Clinical School, University of Auckland; ‡Matamata Medical Centre, Matamata; §Midlands Health Network PHO, Hamilton, New Zealand; and ∥McMaster University, Hamilton, Ontario, Canada.
authors.forename: Douglas
authors.initials: D
authors.lastname: White
authors.forename: Kamal
authors.initials: K
authors.lastname: Solanki
authors.forename: Vicki
authors.initials: V
authors.lastname: Quincey
authors.forename: Andrew
authors.initials: A
authors.lastname: Minett
authors.forename: Gordon
authors.initials: G
authors.lastname: Tam
authors.forename: Alan
authors.initials: A
authors.lastname: Doube
authors.forename: Ray
authors.initials: R
authors.lastname: Naden
mesh_terms: D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009520:New Zealand; D058007:Physicians, Primary Care; D016730:Program Development / Q000379:methods*; D012219:Rheumatology / Q000458:organization & administration*