Achievement of NICE quality standards for patients with new presentation of inflammatory arthritis: observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis.
A national audit was performed assessing the early management of suspected inflammatory arthritis by English and Welsh rheumatology units. The aim of this audit was to measure the performance of rheumatology services against National Institute for Health and Care Excellence (NICE) quality standards (QSs) for the management of early inflammatory arthritis benchmarked to regional and national comparators for the first time in the UK.



All individuals >16 years of age presenting to rheumatology services in England and Wales with suspected new-onset inflammatory arthritis were included in the audit. Information was collected against six NICE QSs that pertain to early inflammatory arthritis management.



We present national data for the 6354 patients recruited from 1 February 2014 to 31 January 2015; 97% of trusts and health boards in England and Wales participated in this audit. Only 17% of patients were referred by their general practitioner within 3 days of first presentation. Specialist rheumatology assessment occurred within 3 weeks of referral in 38% of patients. The target of DMARD initiation within 6 weeks of referral was achieved in 53% of RA patients; 36% were treated with combination DMARDs and 82% with steroids within the first 3 months of specialist care. Fifty-nine per cent of patients received structured education on their arthritis within 1 month of diagnosis. In total, 91% of patients had a treatment target set; the agreed target was achieved within 3 months of specialist review in only 27% of patients. Access to urgent advice via a telephone helpline was reported to be available in 96% of trusts.



The audit has highlighted gaps between NICE standards and delivery of care, as well as substantial geographic variability.
Rheumatology Department, Portsmouth Hospitals NHS Trust, Portsmouth Jo.ledingham@porthosp.mhs.uk.
Joanna M
JM
Ledingham
Rheumatology Department, Pennine MSK Partnership, Oldham.
Neil
N
Snowden
Clinical Affairs Department, British Society for Rheumatology.
Ali
A
Rivett
Rheumatology Department, King's College Hospital, London.
James
J
Galloway
Clinical Affairs Department, British Society for Rheumatology.
Zoe
Z
Ide
Rheumatology Department, Pennine MSK Partnership, Oldham.
Jill
J
Firth
Rheumatology Department, Lancashire Care NHS Foundation Trust, Preston.
Elizabeth
E
MacPhie
MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
Ngianga
N
Kandala
MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
Elaine M
EM
Dennison
Clinical Affairs Department, British Society for Rheumatology.
Ian
I
Rowe
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001168:Arthritis / Q000175:diagnosis / Q000188:drug therapy; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000188:drug therapy; D019985:Benchmarking; D054869:Clinical Audit; D019468:Disease Management; D004739:England; D005260:Female; D058006:General Practice; D006297:Health Services Accessibility; D015277:Hotlines; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards; D011787:Quality of Health Care; D012017:Referral and Consultation; D012219:Rheumatology / Q000592:standards*; D012648:Self Care / Q000592:standards; D013997:Time Factors; D061665:Time-to-Treatment; D006113:United Kingdom; D014852:Wales; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents
DMARDs; education (patients); health policies; immunosuppressants; outcome measures; primary care; rheumatoid arthritis; spondyloarthritis; spondyloarthropathies
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