[Improvement of the diagnostic accuracy in patients with suspected rheumatic disease by preselection in the early arthritis clinic : An alternative to the appointment service point model of the Healthcare Improvement Act].
The diagnosis and treatment of inflammatory rheumatic diseases can be delayed by a long waiting period for an appointment with a rheumatologist. This study investigated whether preselection of patients in an early arthritis clinic is a suitable tool to improve this situation. In 2006 an early arthritis clinic was founded by the Collaborating Center of Rheumatology in Halle (Saale). General practitioners refer patients by using a special registration form that helps to identify patients with an early joint swelling or inflammatory back pain. Patients are then allocated to a pool of participating rheumatologists and are seen by one of them within 2 weeks. For our scientific evaluation the data of 248 patients from the early arthritis clinic and data of 187 regular patients were gathered by means of an additional questionnaire for rheumatologists and patients. In the early arthritis clinic 40.3 % of patients received the diagnosis of an inflammatory rheumatic disease compared with 19.3 % in the control group. In the latter group 51 % were diagnosed as having degenerative joint or spine disorders compared with 22 % in patients from the early arthritis clinic; however, 61 % of patients who were referred to the early arthritis clinic did not fulfill the criteria of the registration form. On the other hand, patients in this group fulfilling these criteria had an inflammatory rheumatic disease in 68.1 % of the cases. The mean duration of symptoms at the time of first rheumatological consultation was significantly shorter in the early arthritis clinic than in the control group (6 vs. 39 months). Our data demonstrate that the preselection of patients can serve as a useful instrument to guide the referral of patients to rheumatologists. The high percentage of patients who did not fulfil the criteria of the registration form indicates that a further improvement of this form is necessary and stresses the need for intensive communication between rheumatologists and general practitioners. Early arthritis clinics may be an alternative to the current efforts of the legislative authorities to improve specialist care by centralized distribution of specialist appointments.
Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland. gernot.keyszer@uk-halle.de.
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Keyßer
Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland.
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Oye
Rheumatologische Facharztpraxis, Kleine Marktstr. 3, 06108, Halle (Saale), Deutschland.
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Feist
Rheumatologische Facharztpraxis, Pestalozzistr. 2a, 06128, Halle (Saale), Deutschland.
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Liebhaber
Rheumatologische Facharztpraxis, Pestalozzistr. 2a, 06128, Halle (Saale), Deutschland.
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Babinsky
Orthopädische Facharztpraxis, Geiststr. 15, 06108, Halle (Saale), Deutschland.
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Schobess
Rheumatologische Facharztpraxis, Domplatz 11, 39104, Magdeburg, Deutschland.
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Boldemann
Rheumatologische Facharztpraxis, Ludwig-Wucherer-Str. 10, 06108, Halle (Saale), Deutschland.
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Wagner
Rheumatologische Facharztpraxis, Ludwig-Wucherer-Str. 10, 06108, Halle (Saale), Deutschland.
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Linde
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000145:classification / Q000175:diagnosis*; D019091:Critical Pathways / Q000458:organization & administration; D042241:Early Diagnosis; D017598:Efficiency, Organizational; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D017146:Models, Organizational; D058996:Quality Improvement; D012017:Referral and Consultation / Q000458:organization & administration*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
Degenerative joint diseases; Early arthritis consultation clinic; Healthcare-Improvement-Act; Inflammatory rheumatic diseases; Rheumatological care