New push to speed up referral times for children with arthritis
Researchers in Newcastle are hoping to speed up the time it takes to get children with arthritis referred for appropriate care and treatment.
Currently some children with arthritis in the local area are facing “considerable delays” in being diagnosed and referred to specialist hospital care. The reasons for this are being explored by the research team, but may include a lack of awareness that the condition can affect young as well as older people.
A pilot study conducted by a team at Newcastle University’s Musculoskeletal Research Group revealed that while some youngsters had good experiences of the referral process and were referred for care and treatment within a matter of weeks, in others the significance of their symptoms may have been overlooked.
Now Dr Helen Foster and Professor Carl May have been awarded almost £162,000 over three years by the Arthritis Research Campaign (arc) to explore the factors that influence the referral process, and access to paediatric rheumatology services, and to try and improve the situation.
“It is important for children with arthritis to be referred to hospital quickly,” said Dr Foster. “By the time these children initially come to paediatric rheumatology with prolonged, untreated active arthritis, they have problems with mobility, which we believe could have been avoided if referral had been made sooner.”
Newcastle is a leading centre for research into childhood arthritis and Dr Foster, an arc clinical senior lecturer also runs regular clinics at the Royal Victoria Infirmary, where she is a paediatric rheumatologist. But despite the city’s pre-eminence in this field, the level of awareness of childhood arthritis among doctors in primary and secondary care is often low. Parents too are sometimes unaware that very young children can develop the condition and may not seek medical attention.
Dr Foster said the problem was national, not necessarily regional, with clinical colleagues in other cities reporting similar difficulties. Some children with arthritis in Newcastle were referred quickly and effectively by GPs for specialist treatment, but the spectrum of the length of referral time was “huge.”
The team expect to find a number of factors contributing to delays in referral. One is the acknowledged need for further training in clinical skills and knowledge about childhood arthritis, which needs to be directed at all health care professionals that these children may have contact with.
“We know that children present to paediatric rheumatology services in a variety of ways, not just by seeing their GP. Many are seen directly by different sorts of doctors such as accident and emergency, paediatrics and orthopaedics,” said Dr Foster.
“The feedback we have got from the pilot is that sometimes arthritis is not considered as a diagnosis when they see a child with a limp or sore joints. Many of the parents who took part in our pilot study were told that their child had growing pains. There is huge ignorance out there about arthritis in children.”
The parents of one child whose joint pain had been dismissed as growing pains only went back to the GP after the child’s teacher told them that their child was unable to write properly in class. When the child finally got to see a paediatric rheumatologist, arthritis was evident.
During the three-year project Dr Foster and her team will interview up to 30 families of affected youngsters, and health care professionals, including family doctors and hospital doctors, before putting forward ways of improving the referral process. One solution may be to have a GP within a group of practices specialising in musculoskeletal problems in children who could act as the central point for GPS and refer children as necessary.
The project in Newcastle is part of a bigger picture of raising awareness about childhood arthritis among the medical profession. With arc funding Dr Foster has already produced a DVD for medical students to help them improve their examination skills of the musculoskeletal system and the research team (Professor May, Dr Lesley Kay and Dr Tim Rapley) is currently working on a more detailed examination aimed at children. With Sunderland GP Dr Donna Boyd, Dr Foster is looking at ways of improving the education about musculoskeletal conditions in children among trainee GPs.
arc is a leading funder of research aiming to improve the treatment of children with arthritis, which affects 12,500 youngsters under the age of 17 in the UK.
