Title: Help seeking behaviour in patients with new onset rheumatoid arthritis: understanding the reasons for delay in GP consultation and strategies to reduce this delay.
Funder: Department of Health (England)

Abstract: Background Rheumatoid arthritis (RA) is common, affecting 1% of the adult population. Highly effective drugs are now available to control disease progression in patients with RA. A delay in the introduction of therapy leads to worse long term outcomes and there is strong evidence that the first 3 months represents a therapeutic window of opportunity. We have shown that there is often a considerable delay between symptom onset and assessment by a rheumatologist (median delay 6 months). Importantly, delay in GP consultation by the patient (median delay 3 months) is the principal reason for this. In a qualitative study we have identified key themes influencing how quickly medical advice is sought. Importantly, lack of knowledge about RA often contributed to a delay in presentation. Aims [1] To develop a psychometrically robust questionnaire to assess the reasons for delay in GP consultation in patients with RA and early undifferentiated arthritis. [2] To use this to determine the prevalence of each reason for delay in a large inception cohort and to study the relationship between these and biopsychosocial variables to identify key reasons for delay in well defined subgroups within the population. [3] To use these findings to develop core patient experience based strategies to reduce patient delay. [4] To disseminate information to the public through disease specific organisations and other routes. Plan of Investigation We will develop and validate a questionnaire ensuring face, content and construct validity and reliability over time. This questionnaire will be used in an inception cohort of RA and undifferentiated arthritis patients recruited from Birmingham, Derby, London and other ERAN centres to assess the prevalence of the reasons underlying delay and to study their relationship with biopsychosocial variables. Regression analysis will be used to identify predictors of delay. We will interpret this data in collaboration with patients and the public to identify strategies to reduce delay and develop informational material for dissemination to the public. Patients and the public will be involved throughout the study - this will be facilitated through the NHS Centre for Involvement in Warwick. Potential Impact Rheumatoid arthritis causes joint destruction and significant disability; 30% of patients stop work within 5 years of diagnosis. Furthermore, RA is also associated with reduced life expectancy, mostly due to accelerated cardiovascular disease. The observation that prompt intervention improves long term outcomes means that there is an urgent need for strategies to reduce delays in the initiation of appropriate therapy. By identifying the reasons underlyling the most important factors influencing this delay (patient beliefs and behaviours), our research will provide an evidence based foundation from which to develop appropriately targeted approaches to reduce the delay in GP consultation by patients.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: INFLAMMATORY AND IMMUNE SYSTEM