Referral Delays in Rheumatoid Arthritis Patients Linked to Physician Reluctance, Knowledge Gaps, and Patient Factors: Study

A study published in the Journal of The Association of Physicians of India, suggests both
patient and healthcare professional factors are responsible for referral delays in RA patients. Limited knowledge
of rheumatology, lack of rheumatologists, and hesitation in referring
patients to specialists are the major contributing factors causing referral delays.

RA is a chronic autoimmune disorder that affects
joints, leading to inflammation, pain, swelling, and eventual joint
destruction. The delayed introduction of disease-modifying
antirheumatic drugs (DMARDs) has led to major challenges in RA management,
increased disease burden, and treatment outcomes.

To find out the leading cause behind delayed referral
and treatment, Chandrashekara
S Managing Director, Department of Rheumatology and Clinical Immunology, Bengaluru,
Karnataka, India, and colleagues gathered
to carry out a prospective, multicenter, observational study that enrolled
4,643 RA patients from eight centers using the Indian Rheumatology Association
(IRA) database.

Factors related to the patient and referral were
identified based on the patient’s account. Modified
PRASAD scale to categorize patients’ socioeconomic status.

Results reveal the following
findings:

• The
  predominant factor causing delay was a lack of
  awareness
• 39% of patients were referred to the rheumatology specialty
  within 6 months of disease onset, while 26% reported later, and 34% reported
  over 2 years.
• Socioeconomic factors lead to referral delays in
  Madhya Pradesh (21.43%) and West Bengal (28.57%).
• Lack of awareness about the disease and rheumatology
  specialty was highest in West Bengal (100%), followed by Delhi and Rajasthan
  (93.70%).
• Other factors influencing referral delay were
  misconceptions about modern medicine, reluctance to refer patients to the
  rheumatologist, and previous treatment by other specialties.
• In Gujarat (33.56%) and Delhi and Rajasthan (25.18%)
  primary
  care clinicians’ lack of awareness about the rheumatology specialty was the
  main reason for the delay in referrals.

“The study’s findings may
be limited in their generalizability due to uneven recruitment from various
centers, lack of geographic representation, and potential recall bias,”
researchers reported.

Reference: S Chandrashekara,
Shenoy Padmanabh et al. Blockades in the Pathway of Specialty Care in
Rheumatoid Arthritis: A Report Based on Indian Rheumatology Association
Database. Journal of the Association of Physicians of
India, 72(8).doi: 10.59556/japi.72.0495.