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Embedded digital strategies for Msk screening questioning for suspected inflammatory arthritis

This initiative has been a particularly important for improving screening for suspected axial and peripheral spondyloarthritis which needs questioning on extra-articular features and checking for signs, symptoms and risk factors that raise suspicion in addition to prolonged morning stiffness. Normal blood tests do not rule out these conditions. The aim is to reduce common delays in diagnosis that can be 8-9 years for many people.

We have used  NICE guidance [NG65 & NG100] referral criteria, NICE interactive flowcharts, National Axial Spondyloarthritis Society and ASAS tools and resources to support this screening initiative

 

The screening tool has helped as a clinical education strategy and to support clinical reasoning decisions on timely and appropriate referral for suspected inflammatory arthritis. This initiative is helping meet the national challenge of early referral and supporting better outcomes through earlier diagnosis on inflammatory disease as a shared responsibility across primary and secondary care services and specialties.

Referral content has also been improved and more thorough inclusion of findings that has aided rheumatology triage decisions.  Auditing the impacts on time to diagnosis is an important concurrent initiative.

[Resources: NG65 Interactive pathway - Recognition and Referral - https://pathways.nice.org.uk/pathways/spondyloarthritis#path=view%3A/pathways/spondyloarthritis/referral-for-suspected-axial-spondyloarthritis.xml&content=view-index

;

Recognition and referral guide -  https://www.esht.nhs.uk/wp-content/uploads/2018/07/Msk-Think-SpA-NICE-guidance-on-recognition-and-referral-of-Spondyloarthritis.pdf

SPADE tool for screening for features of Inflammatory  Back Pain that could be due to undiagnosed axSpA - http://www.spadetool.co.uk/

NG100 (RA)  https://pathways.nice.org.uk/pathways/rheumatoid-arthritis ]

What is needed to sustain the change?

Support to help  services design and embed screening into the various software programmes that are being used in primary care triage and assessment services would be valuable. Sharing these developments would help enable wider adoption along with attention needed to minimise user burden and optimise effectiveness of screening support within digital assessments and notes systems 

What is your region?

South East

edited on Sep 30, 2020 by Kyle Beacham
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chris mercer May 13, 2020

Great share thanks Carol- how can we support sharing?

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Carol McCrum May 13, 2020

Some thoughts- Would be helpful to understand and share what other Msk services have in place for e-screening for inflammatory conditions. It would be interesting to also scope the range of software being used for electronic assessments and if those with screening strategies in place for serious pathology also have inflammatory arthritis and SpA screening included. We are using Systm1 locally with some variation in configuration within its processes and templates in different services.

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Katie Knapton May 13, 2020

Brilliant work and the NICE guidelines are in our training system.

Just need to check it is rolled out to all MSK clinicians

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Greta McLachlan Jun 15, 2020

Status labels added: Remote Monitoring, Screening, Supported Self-Management, Triage

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Greta McLachlan Jun 16, 2020

Status labels added: Education, Investment In Technology, Pathway Redesign, Upskilling Of Staff, Horizon 2

Status label removed: Supported Self-Management

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Greta McLachlan Jun 16, 2020

The idea has been progressed to the next milestone.

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Kyle Beacham Jul 10, 2020

Status labels removed: Education, Investment In Technology, Pathway Redesign, Remote Monitoring, Screening, Triage, Upskilling Of Staff

Reply 0