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

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.