National audit results

Marwan Bukhari on behalf of SGAWG

Audit standard

• Patients with RA should be referred within twelve weeks of symptom onset

• Once referred they should be seen within six weeks

• DMARDS should be started without delay

results

• 1313 fully returned questionnaires were analyses in the period

• 890 (67%) female• 1153 (89%) caucasian

Age at onset

Age range Number %16-30 84 6.4%31-50 376 28.6%51-70 585 44.6%> 70 260 40.4%

Time to start

325 25.3%

957 74.4%

Time from disease onset to GP referral

weeks Number %0-3 137 10.54-6 209 16.17-9 119 9.2

10-12 114 8.8>12 716 55.3

Time from GP referral to hospital

weeks Number %0-3 366 28.24-6 532 41.07-9 219 16.9

10-12 89 6.9>12 90 6.9

Time from hospital to DMARD

weeks Number %0-3 634 48.94-6 236 18.27-9 122 9.4

10-12 62 4.8>12 243 18.7

Delay between hospital and DMARD

557 42.6%

751 57.4%

Cause of delay

cause N %Diagnostic uncertainty 334 59.3

Contra-indication 28 5.0Lack of follow up slots 46 8.2

other 154 27.4

101

31

58

71

91 36

175

127

181

139

153

Variation in regions

• Gender – lowest females N west (55%)– Highest females east and west midlands (75%)

• Ethnicity– Most london (49% caucasian)– Least N Ireland (100% caucasian)

Variations in age at onset

• 11 % 17-30 west midlands vs 6 % nationally• Most others similar across regions

• Region with least over 70’s is N Ireland (9.7%) vs around 20% nationally

Variation in starting DMARD

• Before 12 weeks– Best east midlands 36.4% , worst Wales 12.97%

• From hospital to starting DMARD quickest East midlands N ireland and scotland (>70% less than 3 weeks)

• slowest East and Yorkshire(>20% waiting more than 12 weeks from hospital to DMARD

Onset to referral > 12 weeks

Time from referral to seen <6 weeks

Delay in starting DMARD

Conclusions

• Average return of data

• Still not achieving national targets

• Delays from onset to referral, from referral to being seen and on start of first DMARD