Triage tool for GP referrals highly sensitive

Rheumatoid arthritis

By Clare Pain

25 Mar 2015

A prioritisation tool developed by Australian rheumatologists to ensure the patients most likely to have RA are seen quickly by a specialist is highly sensitive, detecting 96% of RA cases, and significantly reduces their waiting times.

Lead author, Dr Lisa Cummins, a rheumatologist at the Princess Alexandra Hospital in Brisbane, says: “Early treatment for RA is vital. By applying the 2010 ACR/EULAR RA criteria to GP referral letters, we hoped to identify the patients with RA, and reduce delays in treatment.”

The study was conducted over eight months in 2011 at Townsville Hospital. One hundred and forty three referrals were triaged using the new tool, which assessed 71 of these referrals as being patients likely to have RA.

These ‘high risk’ patients were treated as urgent, waiting for a median time of 7.9 weeks for their first appointment with a rheumatologist. Forty percent of those attending that appointment were diagnosed with RA.

The median waiting time for the 72 patients judged not to be at high risk of RA by the tool was 45.4 weeks. One of these patients later received an RA diagnosis on seeing the rheumatologist.

The tool spotted 96% of the patients who were subsequently diagnosed with RA, but did give a high percentage of false positives – only 40% of those put into the ‘high RA risk’ group actually had the disease. However, Cummins points out, this is precisely what is required of a screening tool.

“It worked well at detecting people with RA and that’s partly because we had an inclusive approach in the way we categorised the letters,”  Cummins told the limbic.

They used a slightly more lax requirement than the strict ACR/EULAR criteria, including an affected joint count but not requiring mention of swollen joints in the GP’s referral letter, she says.

“One of the reasons we decided to do this study in Townsville was that there is a workforce shortage of rheumatologists in QLD and very long waiting lists,” says Cummins. She thinks the tool will be particularly useful in such areas of specialist scarcity.

The study was published in  Arthritis Care and Research.

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