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
{"title":"Implementation of an Early Referral Programme for Patients With Hand Arthralgia.","authors":"David Vega-Morales, Alain Nigel Michele Granados Silva, Alondra Elizabeth Montoya-Montes","doi":"10.1111/jep.14291","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>The implementation of this early referral programme significantly reduced the time in months for patients to access rheumatologic care.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":"e14291"},"PeriodicalIF":2.1000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of evaluation in clinical practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/jep.14291","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
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.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
求助全文
约1分钟内获得全文 去求助
来源期刊
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.
期刊最新文献
On Lateness: The Ethics of Running Behind Schedule in General Practice. Implementation of an Early Referral Programme for Patients With Hand Arthralgia. Improving Nursing Students' Learning Outcomes in Neonatal Resuscitation: A Quasi-Experimental Study Comparing AI-Assisted Care Plan Learning With Traditional Instruction. Integrated Care Implemented in the Children's Hospital From the Interwar Period as the Source of Good Practices for the Contemporary Concept of Coordinated Care Based on the WHO Model. Lack of Prescription Drug Benefit Knowledge and Problems Paying Medical Bills Among Medicare Beneficiaries.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1