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Self-Assessment Triage for Inflammatory Arthritis: A Pilot Randomized Controlled Trial.

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Adding the Early Inflammatory Arthritis Detection Tool (EIADT) to rheumatology referral letters may improve patient triage. This self-assessment tool helps identify nonurgent cases, potentially optimizing rheumatologist referrals for inflammatory arthritis.

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Area of Science:

  • Rheumatology
  • Clinical Triage
  • Inflammatory Arthritis

Background:

  • Prompt rheumatologist referral is crucial for preventing joint damage in inflammatory arthritis (IA).
  • Effective triage systems are needed to manage patient flow and prioritize care.

Purpose of the Study:

  • To evaluate if including self-assessment tools, specifically the tender joint count (TJC) and the Early Inflammatory Arthritis Detection Tool (EIADT), improves the triage of new rheumatology referrals.
  • To determine if these tools enhance the accuracy of urgency ratings compared to standard referral letters.

Main Methods:

  • A randomized 2x2 factorial design study involving 202 newly referred patients without prior IA.
  • Patients were allocated to groups receiving: no self-assessment, TJC + EIADT, TJC only, or EIADT only.
  • Urgency ratings were assigned based on referral letter alone, referral letter with self-assessment, and clinical assessment.

Main Results:

  • In the EIADT group, adding self-assessment to the referral letter significantly increased the proportion of nonurgent ratings compared to the referral letter alone (P < 0.05).
  • No significant increase in nonurgent ratings was observed in other groups when self-assessment tools were added.
  • Clinical assessment did not significantly further increase nonurgent ratings compared to referral letter plus EIADT in the EIADT group.

Conclusions:

  • The Early Inflammatory Arthritis Detection Tool (EIADT), when included with referral letters, shows potential for improving the triage of new inflammatory arthritis referrals.
  • This tool may aid in more accurately identifying patients who do not require immediate rheumatologist consultation.