13 October 2022
Latest figures released from the National Early Inflammatory Arthritis Audit (NEIAA) reveal how rheumatology units have performed against national guidance during the recovery phase of the Covid-19 pandemic.
Published today, the fourth annual report is the latest from this audit which is the largest and most comprehensive study of its kind. The audit aims to improve patient care and treatment.
Data was gathered between April 2021 and March 2022 and collection was mandated from May 2021. Re-engagement with the audit increased progressively through the year, with over 100 trusts and health boards in England and Wales participating and information gathered from over 11,700 patients.
Despite the pressures on community services exacerbated by the pandemic, there has been an improvement in the proportion of patients being referred from their GP within the three-day NICE target. This was up to 54% from 47% in year two before the pandemic.
There has been a decrease in the proportion of patients seen by a rheumatology specialist within the recommended three weeks (42% compared to 48% in year two). This wasn’t unexpected given most Trusts and Health Boards had staff deployed away from rheumatology services during the pandemic.
Time to treatment remained steady, with 65% of patients receiving disease modifying anti-rheumatic drugs within the six-week guideline, suggesting services have found ways to prioritise this work.
Dr Jo Ledingham, the audit’s Clinical Director, said: “We know that Covid has had a significant impact on rheumatology services, so we’d like to say thank you to all the units that submitted data. Given everything that has been thrown at the NHS over the last few years, it’s a testament to the rheumatology community’s desire to provide high-quality care that standards have not dropped as much as we might have expected.
“We must be cautious when making comparisons to previous years because we haven't achieved pre-pandemic levels of engagement from Trusts and Health Boards yet.
“We’ve relied more heavily on what patients tell us about outcomes during the pandemic. This needs to be considered when interpreting the reported drop in the proportion of patients achieving remission at three months as assessed by DAS28 scores.
“However, it’s good to see meaningful improvements in all the other patient reported outcomes assessed in this audit, including measures of the impact of inflammatory arthritis on function, mental health and ability to work.”
Other key findings from the data include:
- Availability of early arthritis clinics hasn’t increased (and access to recommended allied health professional services, especially psychology, remains suboptimal
- The majority of patients received disease education and self-management support, but there is ongoing variability in clinician and patient reported experience
- Delays in specialist review remain much greater for patients with a diagnosis of axial spondylarthritis.
Dr Ledingham continued: “We’d like to encourage more units to participate in the audit. We understand they might struggle and be fearful of submitting data, but it’s important we get an accurate picture of what impact the pandemic has had on rheumatology services.
“There’s still a long way to go in terms of achieving optimal care and early remission, but we’d like to reassure units that our aim, within the audit team and at BSR, is to support them. There is an opportunity to take stock and review the services we provide, as we work to rebuild and improve them.”
Click here for the report.