A retrospective cohort in CPRD Aurum primary care records compared referral routes for 71,145 patients newly diagnosed with IBD, Parkinson's disease or lupus. Advice and Guidance, where a GP seeks specialist advice before referring, was recorded for 3.0% to 4.9% of patients between 2015 and 2022. Compared with elective referral only, time to diagnosis was longer by 15.9 weeks for IBD (hazard ratio 0.58, 95% CI 0.52 to 0.66). The equivalent differences were 11.4 weeks for Parkinson's disease and 6.3 weeks for lupus. Time to first definitive treatment and to first attended outpatient appointment did not differ between the two routes. The design is observational, and the authors state that it does not establish that Advice and Guidance caused the longer interval.
Why it is interesting: Sets out how a GP's pre-referral advice request relates to diagnostic intervals in three conditions, for those analysing NHS referral pathways. Diagnosis came later, yet time to treatment and to first outpatient appointment did not.
Abstract — the authors' own words, CC BY
Objective:
To determine outcomes by referral route (any Advice and Guidance [A&G] versus elective referrals only) for patients with inflammatory bowel disease (IBD), Parkinson′s disease, and systemic lupus erythematosus (SLE). Design:
Population-based retrospective cohort study. Setting:
Linked Clinical Practice Research Datalink (CPRD) Aurum primary care records, 2015-2022. Participants: Patients with incident diagnosis of IBD, Parkinson′s disease, or SLE. Main Outcome Measures: Time from the earliest recorded A&G or elective referral to diagnosis, first recorded definitive treatment and first attended outpatient appointment. Secondary outcomes included counts of primary care consultations, prescriptions, referrals, and outpatient appointments. Propensity score weighted flexible parametric survival analyses accounted for differences between exposure groups. Results:
Among 71,145 eligible patients, A&G was recorded for 1,137 (3.0%) with IBD, 971 (3.4%) with Parkinson′s, and 243 (4.9%) patients with SLE. Compared with elective referral only, A&G was associated with slower time to diagnosis for IBD (adjusted median difference 15.9 weeks; hazard ratio 0.58, 95% confidence interval 0.52 to 0.66), Parkinson′s disease (11.4 weeks; 0.57, 0.51 to 0.64), and SLE (6.3 weeks; 0.82, 0.73 to 0.91). However, A&G was not associated with a longer time to treatment or first attended outpatient appointment. An increase in primary care consultations following A&G was observed in patients later diagnosed with IBD and SLE. Conclusion:
A&G was associated with a longer diagnostic interval than elective referral only. These findings do not establish that A&G caused diagnostic delay. A&G might be used at an earlier stage of more complex diagnostic pathways.
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