The influence of ethnicity on the extent of, and reasons underlying, delay in general practitioner consultation in patients with RA

Objective. Delay in assessment by rheumatologists of patients with new-onset RA is an important determinant of delay in treatment initiation. The influence of ethnicity on delay in assessment has not been addressed. We studied the extent of delay in patients of South Asian origin compared with other patients and the reasons underlying this delay. Methods. Data were collected from 272 patients with RA at the time of assessment by a rheumatologist; 43 were of South Asian origin. Delays were recorded at the level of the patient seeking advice from the general practitioner (GP), the GP referring to secondary care and the rheumatologist seeing the patient after the referral had been made. In addition, using qualitative methods, we assessed the reasons underlying delay in help-seeking behaviour in 10 patients of South Asian origin. Results. Patient delay was significantly longer in patients of South Asian origin than in other patients. Delays at the level of primary and secondary care were not different. Four interlinking themes influenced how rapidly early RA patients of South Asian origin consulted their GPs: symptom experience, symptom evaluation, existing ideas, and knowledge of RA and influence of friends and family. Conclusions. Patient-dependent factors leading to delays in GP consultation, are the principal reason for the considerable delay in RA patients of South Asian origin being seen by rheumatologists. An understanding of the reasons underlying this delay will inform the development of interventions to reduce it in this population.