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

The objectives were to test whether the short-term health outcome ofrheumatology out-patients differs according to clinical priority. Thesetting was an NHS regional rheumatology out-patient department serving acatchment population of over 1 million. The subjects were 249 consecutiverheumatology out-patients categorized on the basis of the referral letteras 'urgent' (n = 50), 'soon' (n = 100) or 'routine' (n = 99). Primaryoutcome measures were the proportion of patients reporting improvement inhealth categorized by clinical priority (urgent, soon or routine) or maindiagnostic group (inflammatory or non- inflammatory disease). Secondaryoutcome was change in health status measured using the EuroQol generichealth instrument (EQ-5D). Small but insignificant differences in theproportion of patients reporting health improvement were found between theurgent (28%), soon (23%) and routine (17%) categories (Kruskal-Wallis, P =0.186). Thirty per cent of patients with inflammatory joint diseasereported improvement compared with 17% of those with non-inflammatoryconditions (Mann- Whitney U, P = 0.019). In patients reporting improvement,the median (interquartile range) improvement in EQ-5D health utility scorewas +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 somepatients over others, results in rationing by delay. These data do notsupport the hypothesis that fewer patients given a low clinical prioritygain health benefit compared with those given a high priority. However,those with inflammatory joint disease do appear to have better short-termhealth outcomes.