title: Efficacy and Outcome of Rapid Access Rheumatology Consultation: An Office-based Pilot Cohort Study.
abstract: Waiting times for first appointments are a major obstacle to timely rheumatology care. To improve access, a cooperative of office-based rheumatologists established an immediate access network, offering brief initial assessments for patients with musculoskeletal problems.
  
  
  
  Patients were assessed at presentation and followed up after 6 months. Data were analyzed regarding demographics, diagnostic accuracy, clinical variables such as pain levels, and care.
  
  
  
  There were 335 patients assessed in the 6 cooperating practices during dedicated office hours. There were 124 patients (38%) who had a symptom duration of < 3 months. For patients with rheumatoid arthritis (RA), this proportion was 43% (70% for self-referred patients with RA). In the 325 patients available for reassessment after 6 months, initially suspected diagnoses were confirmed in 88%. Confirmation rates were 93% for RA (59 patients) and 84% for spondyloarthritis (SpA; 46 patients). At the followup examination, the visual analog scale for pain in patients with RA had significantly decreased from a median (interquartile range) of 70 (57.75-80) to 27.5 (20-42). For patients with SpA, the decrease was from 65 (50-79) to 30 (20-40).
  
  
  
  The Rapid Access Clinic resulted in a substantial improvement of access to rheumatology assessment. More than one-third of the patients presented < 3 months after symptom onset. Suspected diagnoses of inflammatory rheumatic diseases were confirmed in almost 90%. This initiative demonstrates the feasibility of a rapid access service and indicates high diagnostic accuracy in such a setting. In particular, with respect to early access, it compares favorably with similar hospital-based approaches.
authors.affiliation: From the Centre of Excellence in Medicine, Linz; Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.R. Puchner, MD, MSc, MBA, Private Practice, Wels; R. Janetschko, MD, Private Practice, Linz; W. Kaiser, MD, Private Practice, Linz; M. Linkesch, MD, Private Practice, Linz; M. Steininger, MD, Private Practice, Steyr; R. Tremetsberger, MD, Private Practice, Weyer; A. Alkin, MSc, Centre of Excellence in Medicine; K. Machold, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna. rudolf.puchner@cc-net.at.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Puchner
authors.affiliation: From the Centre of Excellence in Medicine, Linz; Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.R. Puchner, MD, MSc, MBA, Private Practice, Wels; R. Janetschko, MD, Private Practice, Linz; W. Kaiser, MD, Private Practice, Linz; M. Linkesch, MD, Private Practice, Linz; M. Steininger, MD, Private Practice, Steyr; R. Tremetsberger, MD, Private Practice, Weyer; A. Alkin, MSc, Centre of Excellence in Medicine; K. Machold, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna.
authors.forename: Richard
authors.initials: R
authors.lastname: Janetschko
authors.affiliation: From the Centre of Excellence in Medicine, Linz; Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.R. Puchner, MD, MSc, MBA, Private Practice, Wels; R. Janetschko, MD, Private Practice, Linz; W. Kaiser, MD, Private Practice, Linz; M. Linkesch, MD, Private Practice, Linz; M. Steininger, MD, Private Practice, Steyr; R. Tremetsberger, MD, Private Practice, Weyer; A. Alkin, MSc, Centre of Excellence in Medicine; K. Machold, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Kaiser
authors.affiliation: From the Centre of Excellence in Medicine, Linz; Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.R. Puchner, MD, MSc, MBA, Private Practice, Wels; R. Janetschko, MD, Private Practice, Linz; W. Kaiser, MD, Private Practice, Linz; M. Linkesch, MD, Private Practice, Linz; M. Steininger, MD, Private Practice, Steyr; R. Tremetsberger, MD, Private Practice, Weyer; A. Alkin, MSc, Centre of Excellence in Medicine; K. Machold, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna.
authors.forename: Manfred
authors.initials: M
authors.lastname: Linkesch
authors.affiliation: From the Centre of Excellence in Medicine, Linz; Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.R. Puchner, MD, MSc, MBA, Private Practice, Wels; R. Janetschko, MD, Private Practice, Linz; W. Kaiser, MD, Private Practice, Linz; M. Linkesch, MD, Private Practice, Linz; M. Steininger, MD, Private Practice, Steyr; R. Tremetsberger, MD, Private Practice, Weyer; A. Alkin, MSc, Centre of Excellence in Medicine; K. Machold, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna.
authors.forename: Markus
authors.initials: M
authors.lastname: Steininger
authors.affiliation: From the Centre of Excellence in Medicine, Linz; Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.R. Puchner, MD, MSc, MBA, Private Practice, Wels; R. Janetschko, MD, Private Practice, Linz; W. Kaiser, MD, Private Practice, Linz; M. Linkesch, MD, Private Practice, Linz; M. Steininger, MD, Private Practice, Steyr; R. Tremetsberger, MD, Private Practice, Weyer; A. Alkin, MSc, Centre of Excellence in Medicine; K. Machold, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna.
authors.forename: Raimund
authors.initials: R
authors.lastname: Tremetsberger
authors.affiliation: From the Centre of Excellence in Medicine, Linz; Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.R. Puchner, MD, MSc, MBA, Private Practice, Wels; R. Janetschko, MD, Private Practice, Linz; W. Kaiser, MD, Private Practice, Linz; M. Linkesch, MD, Private Practice, Linz; M. Steininger, MD, Private Practice, Steyr; R. Tremetsberger, MD, Private Practice, Weyer; A. Alkin, MSc, Centre of Excellence in Medicine; K. Machold, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna.
authors.forename: Alois
authors.initials: A
authors.lastname: Alkin
authors.affiliation: From the Centre of Excellence in Medicine, Linz; Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.R. Puchner, MD, MSc, MBA, Private Practice, Wels; R. Janetschko, MD, Private Practice, Linz; W. Kaiser, MD, Private Practice, Linz; M. Linkesch, MD, Private Practice, Linz; M. Steininger, MD, Private Practice, Steyr; R. Tremetsberger, MD, Private Practice, Weyer; A. Alkin, MSc, Centre of Excellence in Medicine; K. Machold, MD, PhD, Professor of Rheumatology, Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna.
authors.forename: Klaus
authors.initials: K
authors.lastname: Machold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain; D010147:Pain Measurement; D017060:Patient Satisfaction; D010865:Pilot Projects; D012017:Referral and Consultation; D012216:Rheumatic Diseases / Q000175:diagnosis*; D012219:Rheumatology; D063189:Symptom Assessment; D061665:Time-to-Treatment; D055815:Young Adult
keywords: EARLY ARTHRITIS CLINICS; HEALTHCARE RESEARCH; QUALITY OF CARE; RAPID ACCESS CONSULTATION; RHEUMATOID ARTHRITIS