EP02 How much time do we spend seeing non-inflammatory conditions? A district general hospital’s perspective
Authors: Saunders Matthew J , Rhys-Dillon Ceril , Jones Catrin M 
Published: April 2020

Abstract

Background
With the ever-increasing pressure of outpatient waiting times affecting rheumatology clinics, we were interested to determine the proportion of non-inflammatory conditions seen in our department. The general consensus among rheumatologists is that non-inflammatory conditions should be managed outside of secondary care, although, these should be referred for specialist opinion where the diagnosis is uncertain. Rheumatologists have a general idea of their current outpatient case load, but to provide a more accurate assessment and to assist with resource planning, we analysed our case load over a one-month period.

Methods
All outpatient follow up and new patient clinics during March 2019 were included in the study. Cancellations and 'did not attends' (DNA) were calculated for statistical analysis, but these patients were excluded from the dataset. Gender and diagnosis data were collected using Rheumatology clinic letters and multiple diagnoses were included if these were deemed to contribute to the original presentation or follow up. The diagnoses were grouped into three broad categories: inflammatory (including rheumatoid arthritis, psoriatic arthritis, undifferentiated arthritis, connective tissue disease, vasculitis, ankylosing spondylitis and rare diseases); non-inflammatory (including osteoarthritis, Ffbromyalgia and non-inflammatory arthralgia) and others (including crystal arthropathy, polymyalgia rheumatica and osteoporosis). The categorisation was based upon the need for patient follow up. Those with inflammatory conditions requiring follow-up, non-inflammatory patients not requiring follow up and others having follow up determined on a case-by-case basis.

Results
43 clinics met the criteria for inclusion, providing a cohort of 532 patients. 121 (22.7%) patients cancelled or DNA and these were excluded. There were 73 (17.8%) new patients, with 80 diagnoses, and 338 (82.2%) follow up patients, with 356 diagnoses, of whom 294 (71.5%) were female. Of the New patients, there were 29 (36.25%) working diagnoses of inflammatory conditions, 41 (51.25%) working diagnosis of non-inflammatory conditions and 10 (12.5%) others. Of the follow up patients, there were 268 (75.3%) inflammatory working diagnoses with 33 (9.3%) having a working diagnosis of a non-inflammatory condition plus 55 (15.4%) others.

Conclusion
More than half of the new patients referred to clinic were diagnosed or suspected to have non-inflammatory conditions. Non-inflammatory conditions rarely required follow up, as reflected by only 9.3% of follow up appointments being allocated to this group. Is this prudent healthcare? Are there alternative ways in which rheumatology teams could work with Primary care to reduce referral rates, enabling earlier diagnosis and treatment in the community for patients with non-inflammatory conditions? Or, is this a valuable service provided by Secondary care, supporting the work of primary care providers? This is a valuable study for our team and further work is now underway within our healthcare community to discuss these findings with primary care teams and to plan accordingly.

Disclosures
M.J. Saunders None. C. Rhys-Dillon None. C.M. Jones None.