Evaluating the impact of Advice and Guidance on diagnostic pathways and healthcare use in England: retrospective cohort study, 2015-2022
- 1Keele University
Abstract
ObjectiveTo determine outcomes by referral route (any Advice and Guidance [A&G] versus elective referrals only) for patients with inflammatory bowel disease (IBD), Parkinsons disease, and systemic lupus erythematosus (SLE).
DesignPopulation-based retrospective cohort study.
SettingLinked Clinical Practice Research Datalink (CPRD) Aurum primary care records, 2015-2022.
ParticipantsPatients with incident diagnosis of IBD, Parkinsons disease, or SLE.
Main Outcome MeasuresTime 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.
ResultsAmong 71,145 eligible patients, A&G was recorded for 1,137 (3.0%) with IBD, 971 (3.4%) with Parkinsons, 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), Parkinsons 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.
ConclusionA&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.
What is already known on this topicO_LIAdvice and Guidance (A&G) enables primary care clinicians to obtain specialist input before or instead of elective referral and is promoted to support patient management and reduce unnecessary outpatient activity. C_LIO_LIEvidence is limited on whether A&G shortens diagnostic and treatment pathways or instead adds an additional step for patients who ultimately require specialist care. C_LIO_LIThe effects of A&G on subsequent primary care workload, secondary care use, and patient safety are uncertain, and implementation varies between local healthcare systems. C_LI
What this study addsO_LIAmong patients subsequently diagnosed with inflammatory bowel disease (IBD), Parkisons disease or systemic lupus erythematosus (SLE), the interval from the earliest recorded A&G or elective referral of any type to diagnosis was longer among those with any recorded A&G although we did not observe an increase time to treatment or first attended outpatient appointment. C_LIO_LIPatients with A&G had more all-cause subsequent referrals across all three conditions and more all-cause primary care consultations for IBD and SLE; no clear differences were found in attended outpatient appointments, unplanned hospital admission, or mortality. C_LIO_LIA&G may identify an earlier stage of the pathway; however, patients recorded with A&G tended to be more complex and findings should be interpreted as associations rather than evidence that A&G caused delay. C_LI
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BibTeX
@misc{mason2026evaluating,
title = {{Evaluating the impact of Advice and Guidance on diagnostic pathways and healthcare use in England: retrospective cohort study, 2015-2022}},
author = {K. J. Mason and V. K. Welsh and K. P. Jordan and J. Bailey and R. Bajpai and L. E. Clarson and A. Faux-Nightingale and T. Hadley-Barrows and J. K. Haines and R. Harrison and T. Helliwell and S. L. Hider and C. Jinks and N. Knight and C. D. Mallen and C. Burton},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.08.26365047},
url = {https://www.medrxiv.org/content/10.64898/2026.10.08.26365047v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Evaluating the impact of Advice and Guidance on diagnostic pathways and healthcare use in England: retrospective cohort study, 2015-2022
AU - K. J. Mason
AU - V. K. Welsh
AU - K. P. Jordan
AU - J. Bailey
AU - R. Bajpai
AU - L. E. Clarson
AU - A. Faux-Nightingale
AU - T. Hadley-Barrows
AU - J. K. Haines
AU - R. Harrison
AU - T. Helliwell
AU - S. L. Hider
AU - C. Jinks
AU - N. Knight
AU - C. D. Mallen
AU - C. Burton
PY - 2026
DA - 2026/10/08
PB - medRxiv
DO - 10.64898/2026.10.08.26365047
UR - https://www.medrxiv.org/content/10.64898/2026.10.08.26365047v1
AB - ObjectiveTo determine outcomes by referral route (any Advice and Guidance [A&G] versus elective referrals only) for patients with inflammatory bowel disease (IBD), Parkinsons disease, and systemic lupus erythematosus (SLE). DesignPopulation-based retrospective cohort study. SettingLinked Clinical Practice Research Datalink (CPRD) Aurum primary care records, 2015-2022. ParticipantsPatients with incident diagnosis of IBD, Parkinsons disease, or SLE. Main Outcome MeasuresTime 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. ResultsAmong 71,145 eligible patients, A&G was recorded for 1,137 (3.0%) with IBD, 971 (3.4%) with Parkinsons, 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), Parkinsons 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. ConclusionA&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. What is already known on this topicO_LIAdvice and Guidance (A&G) enables primary care clinicians to obtain specialist input before or instead of elective referral and is promoted to support patient management and reduce unnecessary outpatient activity. C_LIO_LIEvidence is limited on whether A&G shortens diagnostic and treatment pathways or instead adds an additional step for patients who ultimately require specialist care. C_LIO_LIThe effects of A&G on subsequent primary care workload, secondary care use, and patient safety are uncertain, and implementation varies between local healthcare systems. C_LI What this study addsO_LIAmong patients subsequently diagnosed with inflammatory bowel disease (IBD), Parkisons disease or systemic lupus erythematosus (SLE), the interval from the earliest recorded A&G or elective referral of any type to diagnosis was longer among those with any recorded A&G although we did not observe an increase time to treatment or first attended outpatient appointment. C_LIO_LIPatients with A&G had more all-cause subsequent referrals across all three conditions and more all-cause primary care consultations for IBD and SLE; no clear differences were found in attended outpatient appointments, unplanned hospital admission, or mortality. C_LIO_LIA&G may identify an earlier stage of the pathway; however, patients recorded with A&G tended to be more complex and findings should be interpreted as associations rather than evidence that A&G caused delay. C_LI
ER -