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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
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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
Great share thanks Carol- how can we support sharing?
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Status labels added: Remote Monitoring, Screening, Supported Self-Management, Triage
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Status labels added: Education, Investment In Technology, Pathway Redesign, Upskilling Of Staff, Horizon 2
Status label removed: Supported Self-Management
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The idea has been progressed to the next milestone.
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Status labels removed: Education, Investment In Technology, Pathway Redesign, Remote Monitoring, Screening, Triage, Upskilling Of Staff
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