Implementation of an Early Referral Programme for Patients With Hand Arthralgia.

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice Pub Date : 2025-02-01 DOI:10.1111/jep.14291

David Vega-Morales, Alain Nigel Michele Granados Silva, Alondra Elizabeth Montoya-Montes

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引用次数: 0

Abstract

Introduction: Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease. According to the European League Against Rheumatism (EULAR), the stages of RA progression include pre-RA, preclinical RA, inflammatory arthralgia, arthralgia with positive antibodies, arthralgia suspected of progressing to RA, undifferentiated arthritis and finally established RA. According to the Community Oriented Program for Control of Rheumatic Diseases (COPCORD), the prevalence of RA in Mexico is 1.6% [2], with approximately 10% of health problems addressed at the primary care level.

Objective: To assess the implementation of an early referral programme for patients with RA and to reduce the time from symptom onset to specialist referral within the Mexican healthcare system.

Materials and methods: This was a prospective, observational cohort study conducted in family medicine units affiliated with the HGZ #17 of the IMSS, Delegación Nuevo León. A pilot early referral programme was implemented as follows. Phase 1: Patients presenting with hand arthralgia during the initial consultation were referred for a pre-consultation, where they were assessed using the EULAR classification criteria for clinically suspicious arthralgia. Phase 2: Patients meeting more than four of these criteria were scheduled for a direct appointment with a rheumatologist within 3-4 weeks. During the same timeframe, these patients were compared to 200 first-time referrals to rheumatology between April and October 2023 who followed the standard referral process. The following time intervals (measured in months) were evaluated: (A) From symptom onset to the first primary care consultation, (B) To the referral consultation, (C) To internal medicine, and (D) To rheumatology consultation.

Results: Patients diagnosed with RA in the early referral group were 14 out of 41 (34.1%) compared to 25 out of 200 (12.5%) in the standard referral group. The total duration from symptom onset to rheumatology consultation was 28.5 months (SD 35.07) in the standard referral group versus 5.4 months (SD 8.9) in the early referral group.

Conclusion: The implementation of this early referral programme significantly reduced the time in months for patients to access rheumatologic care.

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实施手部关节痛患者早期转诊计划。

类风湿关节炎（RA）是一种进行性自身免疫性炎症性疾病。根据欧洲抗风湿病联盟（EULAR）， RA的进展阶段包括RA前期、临床前RA、炎症性关节炎、抗体阳性关节炎、怀疑进展为RA的关节炎、未分化关节炎和最终确定的RA。根据以社区为导向的风湿病控制计划（COPCORD），墨西哥的类风湿性关节炎患病率为1.6%，其中约10%的健康问题在初级保健层面得到解决。目的：评估RA患者早期转诊方案的实施情况，并减少墨西哥医疗保健系统从症状发作到专家转诊的时间。材料和方法：这是一项前瞻性、观察性队列研究，在IMSS HGZ #17附属家庭医学单位进行，Delegación Nuevo León。试点的早期转介方案执行如下。第一阶段：在初次会诊期间出现手关节痛的患者被转介进行预会诊，在那里他们使用临床可疑关节痛的EULAR分类标准进行评估。第二阶段：符合以上四项标准的患者被安排在3-4周内与风湿病学家直接预约。在同一时间段内，将这些患者与2023年4月至10月期间遵循标准转诊流程的200例首次转诊风湿病患者进行比较。评估以下时间间隔（以月为单位）：(A)从症状出现到第一次初级保健咨询，(B)到转诊咨询，(C)到内科，(D)到风湿病咨询。结果：早期转诊组41名患者中有14名（34.1%）被诊断为RA，而标准转诊组200名患者中有25名（12.5%）被诊断为RA。标准转诊组从症状出现到风湿病咨询的总时间为28.5个月（SD 35.07），而早期转诊组为5.4个月（SD 8.9）。结论：这种早期转诊方案的实施显著减少了患者获得风湿病治疗的时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of evaluation in clinical practice 医学-卫生保健

CiteScore

4.80

自引率

4.20%

发文量

143

审稿时长

3-8 weeks

期刊介绍： The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.