Rheumatology Services

Arthritis New Zealand is calling for more rheumatologists to meet the recommended ratio of one rheumatologist per 100,000 people.

Arthritis NZ advocates for greater awareness raising of rheumatology as a career in New Zealand and incentivising trained rheumatologists to practise within New Zealand.

Data from 2012 shows that across New Zealand there is a shortage of rheumatologists. New Zealand trains enough rheumatologists, but has a problem with filling vacancies. It is recommended that there is 1 rheumatologist per 100,000 people. In 2012, Northland had just 0.64 FTE per 155,800 people and Nelson Marlborough had 0.5 FTE per 136,800 population (one rheumatologist to 273,600 people).

People are waiting for up to a year for appointments and initial treatments. They are seeing long waiting lists and delayed access to rheumatologists. The faster patients are seen by a specialist, the more effective their treatment and management of their condition. The number of people with conditions such as arthritis is only going to grow. We need more specialist posts to match the need.

It takes at least 7 years to train a rheumatologist.

The need for specialists or Rheumatologists is more keenly felt in rural areas than in the bigger centres.

We want to see an increase in the number of publicly funded rheumatology positions. New Zealand currently (Aug 2017) has 12 trainees. In 2012 there were 26 FTE rheumatologists in New Zealand. We are currently short by at least 20 rheumatologists. (Aug 2017)

Why are rheumatologists important?

There is a widespread unmet need for rheumatology services, and people with IA symptoms who do present at rheumatology, often do not present early enough for maximum benefit from DMARDs.

The importance of rheumatology care for people with IA is outlined in research that shows continuous care by a rheumatologist is strongly associated with regular use of DMARDSs and improved outcomes. Those who receive DMARDs in primary care are significantly less likely to continue with this treatment.

Reviews of prognosis and outcome overwhelmingly support the contention that early IA care is optimised when treatment is managed by a rheumatologist, rather than a GP or other consultant.

Rheumatologists rely on the information supplied by the GP to triage patients with suspected IA and prioritise accordingly. The history of symptoms, clinical markers of inflammation, positive RA antibodies and radiological assessments are all important measures of urgency and used by rheumatology services to prioritise and manage waiting lists (Hutt Valley DHB, 2008).

In New Zealand, where waiting lists are used to ration scarce health resources and monitor health system performance, referral to specialist services through managed and prioritised waiting lists may lead GPs to delay referral until a pre-determined threshold is reached for referral, especially because individuals will be referred back to the GP if the referral is deemed inappropriate (Cumming, 2013).

As of July 2012 in New Zealand the maximum allowable waiting time for FSA is six months from referral. The main aims of this maximum is to improve the consistency in the selection and prioritisation of patients, and for a greater proportion of patients to be treated in priority order and within prioritisation timeframes (Ministry of Health, 2013).

Other

The quality of information the GP forwards to the rheumatologist can impinge on the acceptance of the patient for assessment and the quality of the triage.

References:
2014 Stats
Palmerston North Hospital calls on neighbour to treat arthritis patients
Palmerston North to get arthritis specialist after long wait
Negotiating Barriers: An Investigation of Early Access to Rheumatology Services for Patients with Inflammatory Arthritis in the Wellington Region 

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