The short-term health outcome of out-patient rheumatology consultations in relation to rationing: a pilot study.

SUMMARY The objectives were to test whether the short-term health outcome of rheumatology out-patients diVers according to clinical priority. The setting was an NHS regional rheumatology out-patient department serving a catchment population of over 1 million. The subjects were 249 consecutive rheumatology out-patients categorized on the basis of the referral letter as ‘urgent’ (n= 50), ‘soon’ (n= 100) or ‘routine’ (n= 99). Primary outcome measures were the proportion of patients reporting improvement in health categorized by clinical priority (urgent, soon or routine) or main diagnostic group (inflammatory or non-inflammatory disease). Secondary outcome was change in health status measured using the EuroQol generic health instrument ( EQ-5D). Small but insignificant diVerences in the proportion of patients reporting health improvement were found between the urgent (28%), soon (23%) and routine (17%) categories ( Kruskal‐Wallis, P= 0.186). Thirty per cent of patients with inflammatory joint disease reported improvement compared with 17% of those with non-inflammatory conditions (Mann‐ Whitney U, P= 0.019). In patients reporting improvement, the median (interquartile range) improvement in EQ-5D health utility score was +0.2 (0.58) (P= 0.0001) and that of visual analogue health score was + 5( 16) (P= 0.001). Clinical priority setting, by giving priority to some patients over others, results in rationing by delay. These data do not support the hypothesis that fewer patients given a low clinical priority gain health benefit compared with those given a high priority. However, those with inflammatory joint disease do appear to have better short-term health outcomes.