Gaps in care and their associated drivers evident across the journey of patients with RA
| Stage of patient journey | Gaps in care | Drivers* |
|---|---|---|
| Awareness and prevention | Delays in patients seeking medical advice | Low public awareness14 Lack of patient education19 |
| Referral | Delayed referrals from PCPs to rheumatologist | Limited awareness of PCPs on signs and symptoms of RA20 Long waiting times for specialists21 Joint stiffness and inflammation are common for many other conditions Lack of knowledge regarding the referral pathway or the importance of rapid referral21 |
| Diagnosis | Delay in diagnosis | Complex diagnostic requirements14 Limited availability of imaging facilities21 22 Shortage of rheumatologists22 Limited number of HCPs trained to interpret diagnostic results (including imaging)14 |
| Treatment and management (pharmacological and non-pharmacological) | Delayed treatment initiation Poor patient adherence to therapy Lack of coordinated treatment | Budgetary cap and restrictive clinical recommendations regarding choice of therapy22 Disease management not aimed at optimising quality of life23 Deviation from recommendations, or difficulty in implementing them into clinical practice22 Lack of regular review and engagement with patients’ needs24 Treatment adherence23 Competing lifestyle factors23 |
| Follow-up | Lack of monitoring Suboptimal patient outcomes | Capacity constraint—leading to long waiting time for examinations with imaging modalities22 Lack of regularity in follow-up care22 Access to rheumatologists22 |
*List not exhaustive.
HCP, healthcare professional; PCP, primary care professional; RA, rheumatoid arthritis.