Delayed Care: Research Paints Complex Picture of Treatment Delays

AMSTERDAM—A variety of factors lead to delays in patients seeking medical care for rheumatoid arthritis—from the nature of symptoms to coping tendencies—requiring more awareness from physicians when managing patients, researchers said at EULAR: the Annual European Congress of Rheumatology.

Longer delays in treatment bring about more emotional distress to patients, missed chances to ease symptoms and higher healthcare costs, underscoring the need to sort out why delays happen and try to correct these problems, said Rebecca Stack, PhD, a lecturer in psychology and research at Nottingham Trent University.

She said findings show big disparities in treatment delay exist at centers in different regions across Europe.¹ For example, centers in Birmingham report 12 weeks of delay attributed to patients, whereas centers in Vienna report two weeks of delay due to patients. Centers in Stockholm report two weeks of delay attributed to appointment delays and other causes from healthcare professionals, while centers in Berlin report 10 weeks of delay for those kinds of reasons.

This, Dr. Stack said, shows there is room for improvement in getting patients treatment more quickly.

Data collected from 822 patients in the United Kingdom who were newly presenting with symptoms found that 5.7 weeks of delay were attributed to patients, seven were due to delays by the general practitioner, and 4.8 weeks were due to other delays. Fewer than 20% of the patients saw a rheumatologist within 12 weeks of symptom onset, Dr. Stack said.

Patients with a palindromic symptom onset, in which symptoms moved about or came and went, had a longer delay in treatment than those with non-palindromic symptoms. And patients with an insidious symptom emergence had a longer delay than those with acute emergence, she said.

“We know now that symptom onset is really important,” she said.

Patients try a variety of things before actually seeking professional medical help, including using ice or heat and changing their diet, she said.

“They were more likely to seek spiritual guidance than they were to actually speak to a pharmacist,” Dr. Stack said. “So we know there is potential for pharmacists to offer some interventions and to offer, perhaps, some advice to people.”

She said that better messaging with these issues in mind could help limit patient delay, “as long a they’re put into these communication messages with some sort of psychological theory behind them. … We know we need to also increase their cues to action and their self-efficacy.