Abstract：
OBJECTIVE: This audit describes variation in the time from referral to starting disease modifying drug (DMARD) for people with newly diagnosed seropositive rheumatoid arthritis (RA), how frequently this was within the recommended 6 weeks and whether regional, service-level or patient-level factors were associated with this variation.
METHODS: Rheumatologists submitted data on new patients with a new diagnosis of rheumatoid factor and/or cyclic-citrullinated peptide antibody positive RA. The association between visit funding, ethnicity, socio-economic deprivation, rurality, local specialist staffing levels and the time to DMARD treatment was assessed using Cox proportional-hazard models.
RESULTS: Data were collected on 355 patients over 12 months. Overall, 64.8% of patients commenced DMARD treatment within 6 weeks of referral and this was associated with rheumatologist FTE per 100,000 population (adjusted HR 2.47, 95%CI 1.27-4.81; p=0.008) and the rurality (Geographic Classification of Health [GCH]) of the patient (for R2 compared to U1 adjusted HR 0.20, 95%CI 0.09-0.43; p<0.001). There was no association between time to DMARD and ethnicity or socio-economic deprivation.
CONCLUSIONS: There was significant variation in time to DMARD treatment, mainly related to variation in rheumatologist staffing levels and patient rurality. Rheumatologist staffing levels of 1.0 FTE/100,000 population was associated with 80% of patients meeting the recommended 6-week time to DMARD treatment.
METHODS: Rheumatologists submitted data on new patients with a new diagnosis of rheumatoid factor and/or cyclic-citrullinated peptide antibody positive RA. The association between visit funding, ethnicity, socio-economic deprivation, rurality, local specialist staffing levels and the time to DMARD treatment was assessed using Cox proportional-hazard models.
RESULTS: Data were collected on 355 patients over 12 months. Overall, 64.8% of patients commenced DMARD treatment within 6 weeks of referral and this was associated with rheumatologist FTE per 100,000 population (adjusted HR 2.47, 95%CI 1.27-4.81; p=0.008) and the rurality (Geographic Classification of Health [GCH]) of the patient (for R2 compared to U1 adjusted HR 0.20, 95%CI 0.09-0.43; p<0.001). There was no association between time to DMARD and ethnicity or socio-economic deprivation.
CONCLUSIONS: There was significant variation in time to DMARD treatment, mainly related to variation in rheumatologist staffing levels and patient rurality. Rheumatologist staffing levels of 1.0 FTE/100,000 population was associated with 80% of patients meeting the recommended 6-week time to DMARD treatment.
摘要：
目的：本审核描述了新诊断的血清阳性类风湿关节炎（RA）患者从转诊到开始使用疾病改善药物（DMARD）的时间变化，在建议的6周内，这种情况的频率有多高，以及是否有区域性，服务水平或患者水平因素与这种变异相关.
方法：风湿病学家提交了新诊断为类风湿因子和/或环瓜氨酸肽抗体阳性RA的新患者的数据。访问资金之间的关联，种族,社会经济匮乏，rurality,使用Cox比例风险模型评估了当地专家的人员配备水平和接受DMARD治疗的时间.
结果：收集了355名患者12个月的数据。总的来说,64.8%的患者在转诊后6周内开始接受DMARD治疗，这与每100,000人的风湿病学家FTE（调整后的HR2.47，95CI1.27-4.81；p=0.008）和患者的rurality（健康地理分类[GCH]）（R2与U1调整后的HR0.20，95CI0.09-0.43；p<0.001）相关。DMARD的时间与种族或社会经济匮乏之间没有关联。
结论：DMARD治疗时间有显著差异，主要与风湿病专家人员配备水平和患者乡村性的变化有关。风湿病学家的人员配备水平为1.0FTE/100,000人群，与80％的患者达到DMARD治疗的推荐6周时间相关。
方法：风湿病学家提交了新诊断为类风湿因子和/或环瓜氨酸肽抗体阳性RA的新患者的数据。访问资金之间的关联，种族,社会经济匮乏，rurality,使用Cox比例风险模型评估了当地专家的人员配备水平和接受DMARD治疗的时间.
结果：收集了355名患者12个月的数据。总的来说,64.8%的患者在转诊后6周内开始接受DMARD治疗，这与每100,000人的风湿病学家FTE（调整后的HR2.47，95CI1.27-4.81；p=0.008）和患者的rurality（健康地理分类[GCH]）（R2与U1调整后的HR0.20，95CI0.09-0.43；p<0.001）相关。DMARD的时间与种族或社会经济匮乏之间没有关联。
结论：DMARD治疗时间有显著差异，主要与风湿病专家人员配备水平和患者乡村性的变化有关。风湿病学家的人员配备水平为1.0FTE/100,000人群，与80％的患者达到DMARD治疗的推荐6周时间相关。
