Self-assessment Triage in Inflammatory Arthritis

NCT04956380 | Unknown

• 1 other identifier: 261-2017
• Study Type: interventional
• Target: 207
• Locations: 1 country
• Sites: 2

Brief Summary

There are benefits to early, intensive treatment of IA. But getting to treatment depends on timeline and accurate case identification. The longest delays occur in persons self-identifying the need to see care for IA, recognition of these cases by primary care providers (PCPs), and appropriate, timely referral to rheumatology. Current methods of improving time to referral and consultation are effective, but costly and unsustainable, so there is need to look for alternatives. One solutions may be the use of patient self-administered tools. In this study, we will test whether the use of validated, self-administered patient questionnaires (self-assessment) can advance the urgency rating of referrals for people with inflammatory arthritis (IA). If urgency ratings can be advanced then self-assessment may have the potential to reduce wait times to see a rheumatologist. In Canada, one in every hundred people has IA and hundreds of new patients are diagnosed each year. Wait times to see a rheumatologist are long, so anything that has the potential to reduce these wait times would have a significant impact.

Conditions

Inflammatory Arthritis

Keywords

New Referrals; Triage; Self-assessment

Outcome Measures

Primary Outcomes (1)

• Urgency Rating

  When a rheumatologist receives a new referral, he/she gives it an "urgency rating", which indicates how soon the patient needs to be seen based on information they have about the patient in the referral letter. Urgency rating has four levels: 1) urgent, schedule patient within 4 weeks, 2) urgent, schedule patient in 4 to 6 weeks, 3) urgent, schedule patient in 6 to 12 weeks, 4) non-urgent, schedule patient after 12 weeks. These were developed by the Canadian Rheumatology Association. Please note that these are NOT time points, but ratings used to describe how soon a patient should be seen. Urgency rating will be recorded by the rheumatologist after three different cases: 1) After the rheumatologist receives the patient's referral letter, 2) after the patient arrives for their first appointment and completes a self-assessment in the waiting area, and 3) after the rheumatologist completes their first physical assessment of the patient.

  1 Day

Study Arms (4)

Joint Count + Early Inflammatory Arthritis Detection Tool

EXPERIMENTAL

Rheumatologist reviews both the self-administered tender joint count (out of 68 joints on a homunculus) and self-administered Early Inflammatory Arthritis Detection Tool that were completed by the patient. Rheumatologist then uses the information provided in these tools by the patient to determine whether they should advance the urgency rating of the case.

Other: Self-administered Triage

Early Inflammatory Arthritis Detection Tool

EXPERIMENTAL

Rheumatologist reviews both the self-administered Early Inflammatory Arthritis Detection Tool that was completed by the patient. Rheumatologist then uses the information provided in this tool by the patient to determine whether they should advance the urgency rating of the case.

Other: Self-administered Triage

Joint Count

EXPERIMENTAL

Rheumatologist reviews both the self-administered Patient Tender Joint Count that was completed by the patient. Rheumatologist then uses the information provided in this tool by the patient to determine whether they should advance the urgency rating of the case.

Other: Self-administered Triage

Control

NO INTERVENTION

Rheumatologist does not review any of the self-administered tools completed by the patient.

Interventions

Self-administered Triage OTHER

Self-assessment including a self-administered patient joint count and a self-administered Early Inflammatory Arthritis Detection Tool

Early Inflammatory Arthritis Detection Tool; Joint Count; Joint Count + Early Inflammatory Arthritis Detection Tool

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• new patient referral

You may not qualify if:

• under 18 years of age
• confirmed diagnosis of inflammatory condition
• seen/managed by another rheumatologist within the last five years
• unable to speak English
• on disease modifying antirheumatic drugs.
• referrals from the Emergency Department

Sponsors & Collaborators

• Sunnybrook Health Sciences Centre: lead
• University of British Columbia: collaborator

Study Sites (2)

Dr. Raheem Kherani

Richmond, British Columbia, V7C 5L9, Canada

Location

Sunnybrook Health Sciences Centre

Toronto, Ontario, M4N3M5, Canada

Location

MeSH Terms

Conditions

Arthritis

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Rheumatologist

Model Details: 2x2 factorial randomized controlled trial

Study Record Dates

• First Submitted: April 11, 2018
• First Posted: July 9, 2021
• Study Start: October 31, 2017
• Primary Completion: October 31, 2018
• Study Completion: December 31, 2021
• Last Updated: July 9, 2021

Record last verified: 2021-07

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR
• Time Frame: Data is currently being collected and faxed. Data will remain available for 10 years.

Locations

CA (2)