THE SHORT-TERM HEALTH OUTCOME OF OUTPATIENT RHEUMATOLOGY CONSULTATIONS IN RELATION TO RATIONING - A PILOT-STUDY

The objectives were to test whether the short-term health outcome of r heumatology out-patients differs according to clinical priority. The s etting was an NHS regional rheumatology out-patient department serving a catchment population of over 1 million. The subjects were 249 conse cutive rheumatology out-patients categorized on the basis of the refer ral 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 o r 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 insignifican t differences in the proportion of patients reporting health improveme nt were found between the urgent (28%), soon (23%) and routine (17%) c ategories (Kruskal-Wallis, P = 0.186). Thirty per cent of patients wit h inflammatory joint disease reported improvement compared with 17% of those with non-inflammatory conditions (Mann-Whitney U, P = 0.019). I n patients reporting improvement, the median (interquartile range) imp rovement in EQ-5D health utility score was +0.2 (0.58) (P = 0.0001) an d that of visual analogue health score was +5 (16) (P = 0.001). Clinic al priority setting, by giving priority to some patients over others, results in rationing by delay. These data do not support the hypothesi s that fewer patients given a low clinical priority gain health benefi t compared with those given a high priority. However, those with infla mmatory joint disease do appear to have better short-term health outco mes.