PCPs report feeling uncomfortable making early diagnosis of rheumatoid arthritis
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PHILADELPHIA — Although most primary care physicians understand the importance for early diagnosis and management of rheumatoid arthritis, there is discomfort with making the initial diagnosis, a speaker said at ACR Convergence 2022.
“As there is an important shortage of rheumatologists, not only in Spain but also in Europe and in the USA, it is crucial to improve the training and support for an adequate referral to rheumatology care from primary care,” Isabel Castrejón, MD, PhD, associate professor at Complutense University of Madrid, told Healio in an email correspondence. “In our study, we aim to explore primary care doctors needs to improve referral for patients with rheumatoid arthritis.”
In January, Castrejón and colleagues initiated an early referral program, called REUCARE, which included 257 PCPs. With data collected up to May, 88 patients were referred to rheumatology, but only 27% (n = 24) met inclusion criteria.
According to the poster presentation, a survey was created in collaboration with PCPs to improve referral strategy. The survey explored areas of improvement that included the demographics of the participating PCPs, previous knowledge about RA, confidence level, potential barriers and other factors that influence referral, and interest in rheumatological training.
Of the 257 PCPs who received the survey, 10% (n = 26) responded, and of those 76% were women who had been practicing for more than 20 years. This group of respondents reported seeing 30 to 40 patients a day with approximately one to five patients diagnosed with RA in the last year. Additionally, 83% reported further rheumatological training besides medical school.
Approximately 67% of respondents were aware of the importance of early diagnosis and treatment, according to the poster. Despite this, confidence in making the initial diagnosis was low, with 61% reporting feeling “somewhat confident” and 35% “not confident.” The top reasons for referral were clinical presentation, positive rheumatoid factor and elevation of acute phase reactants.
The researchers reported that 65% of PCPs found the wait list for rheumatology to be prolonged, while 22% found it very prolonged. Moreover, 60% communicated insufficient feedback information from rheumatologists.
From the PCP perspective, the main reasons for delay in referral or diagnosis were nonspecific initial symptoms of the disease and long wait lists. Additionally, Castrejón and colleagues found that 77% of PCPs reported using additional resources to improve their RA knowledge. Furthermore, all participants reported interest in receiving more information on early diagnosis, with 87% preferring a specific e-consult, 78% preferring updated guidelines, and 56.5% preferring face-to face meetings with rheumatologists.
“Most PCPs are aware of the importance of early referral for patients with RA and propose more resources that can be helpful as training, specific guidelines and e-consultation,” Castrejón said. “The rheumatology community need to be aware of these needs from PCP for an early diagnosis and treatment for our RA patients.”
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Bourgeois C, et al. Abstract 0231. Presented at: ACR Convergence 2022; November 11-14, 2022; Philadelphia (hybrid meeting).
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