Diagnostic delay stages and pre-diagnostic treatment in patients with suspected rheumatic diseases before special care consultation: results of a multicenter-based study

Abstract

Early and effective discrimination (triage) of patients with inflammatory rheumatic diseases (IRD) and other diseases (non-IRD) is essential for successful treatment and preventing damage. The aim of this study was to investigate diagnostic delays and pre-diagnosis treatment in patients newly presenting to rheumatology outpatient clinics. A total of 600 patients newly presenting to one university hospital and two non-academic centers were included. Time from onset of symptoms to rheumatology consultation "total delay" as well as medical treatment before consultation were recorded. Median time from symptom onset to rheumatologist appointment (total delay) was 30 weeks. Median time to online search, first physician appointment request and first physician appointment was 2, 4 and 5 weeks, respectively. Total delay was significantly shorter for IRD patients compared to non-IRD patients, 26 vs 35 weeks (p = 0.007). Only 17.7% of all patients and 22.9% of IRD patients had a delay of less than 12 weeks. Total delay was significantly lower in patients seen in non-academic centers compared to the university center, 20 vs 50 weeks (p < 0.0001). 32.2% of IRD patients received medical treatment that eased their symptoms prior to the rheumatology appointment. These findings highlight the persistent diagnostic delays in rheumatology; however, they also suggest that current triage strategies effectively lead to earlier appointments for IRD patients. Improvement of triage methods and pre-diagnosis treatment could decrease overall burden of disease in IRD patients.

Keywords: Delayed diagnosis; Diagnostic delay; Health service research; Outcome research; Time to therapy; Triage.

Fig. 1

A Time from symptom onset to first web search (weeks); B time from symptom onset to first physician request (weeks); C time from symptom onset to first doctors´ appointment (weeks); D time from symptom onset to first rheumatologists´ appointment (weeks), according to inflammatory rheumatic disease (IRD; yes/no) status

Fig. 2

A Time from symptom onset to first web search (weeks); B time from symptom onset to first physician request (weeks); C time from symptom onset to first doctors´ appointment (weeks); D time from symptom onset to first rheumatologists´ appointment, according to university center/practice (weeks)