Scott, I, Mangat, N, MacGregor, A, Raza, K, Mallen, CD and Hider, S (2018) Primary care challenges in diagnosing and referring patients with suspected rheumatoid arthritis: a national cross-sectional gp survey. Rheumatology Advances in Practice, 2 (1). ISSN 2514-1775

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National guidelines advocate referring patients with persistent synovitis to rheumatology within 3 working days of presentation to primary care. This infrequently occurs. We aimed to identify modifiable barriers to early referral of suspected rheumatoid arthritis (RA) patients amongst English GPs.

National cross-sectional survey of 1,388 English GPs (RA-QUEST study). Questions addressed GPs’ confidence in diagnosing RA, clinical factors influencing RA diagnosis/referral, timeliness of referrals, and secondary care access. Data were captured using 10-point visual analogue scales (VAS), 5-point Likert scales, yes/no questions, or free-text, and were analysed descriptively.

Small joint swelling and pain were most influential in diagnosing RA (91% and 84% rated these of 4 or 5 importance on 5-point Likert scale, respectively); investigations including rheumatoid factor (RF; 61% rating 4 or 5) and anti-CCP (72% rating 4 or 5) were less influential. Patient history had the greatest impact on the decision to refer (92% rating this 4 or 5 on 5-point Likert scale), with acute phase markers (74% rating 4 or 5) and serology (76% rating 4 or 5) less impactful. Despite the importance placed on history and examination, only 26% referred suspected RA immediately without investigations; 95% of GPs organising further tests opted to test for RF.

For suspected RA patients to be referred within 3 days of presentation to primary care there needs to be a paradigm shift in GPs’ approaches to making referral decisions, with a focus on clinical history and examination findings, and not the use of investigations like RF.

Item Type: Article
Uncontrolled Keywords: Rheumatoid arthritis; referral; primary care; guidelines
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 28 Mar 2018 07:58
Last Modified: 06 Apr 2019 01:30

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