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King's Fund finds 'stark' differences in care for rheumatoid arthritis

23 January 2009 - 12:30pm

Many patients with rheumatoid arthritis do not receive the care they need because of huge variation in service quality and access to specialists in England, says a major report published yesterday.

The Kings Fund study found ‘stark’ differences across England, with some patients receiving 'no support' from practitioners such as physiotherapists in multidisciplinary teams.

 

Martin Land, one of the report's authors, said: ‘Specialist nursing, physiotherapy and podiatry are crucial to helping patients manage their own conditions. There should be more consistent provision of specialist care and better implementation of guidance and best practice.’

The study was commissioned by the Rheumatology Futures Project Group, a consortium of patient, professional and pharmaceutical organisations.

Disease progresses rapidly without treatment

It surveyed more than 900 patients and 500 medical professionals and NHS staff.

Rheumatoid arthritis (RA) is a chronic, disabling condition with no known cause or cure, that affects around 450,000 people in the UK.

 

Its main symptoms are severe pain, stiffness, fatigue and loss of mobility.

 

Treatment can include drugs, patient education, exercise therapies to maintain muscle strength, and surgery.

 

Management of RA involves specialists including doctors, nurses and allied health professionals.

When untreated,the disease can progress rapidly, causing swelling and damage to cartilage and bone around the joints, commonly the hands, feet and wrists.

Concern about impact of waiting times targets

The Kings Fund found ‘poor clinical understanding’ of RA by many GPs and said improved initial contact in primary care would quicken diagnosis and treatment.

It raises concern that the government’s 18 week referral target, by focusing on new patients, has left many existing RA patients waiting longer for follow-up appointments.

Once referred for specialist care, patients may have access to the wider multidisciplinary team, particularly AHPs, but the extent, availability and timing of this are ‘highly variable.’

 

Some clinicians questioned in the survey said they found such discrepancy ‘striking’ and ‘alarming’.

The study was not designed to identify the causes of such variation or look at comparisons between RA and other disease areas.

‘Extreme inconsistencies’ in monitoring patients

Katy Steward, co-author of the report and a senior fellow at the Kings Fund, said there were some good examples of multidisciplinary teams including physios, to which patients could self-refer.

But she said for many RA patients long-term monitoring of their condition was marked by ‘extreme inconsistencies.’

Perceptions of patients and professionals on rheumatoid arthritis care

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