GPs’ patterns of clinical assessment when faced with a patient suspected for spondyloarthritis: a prospective educational intervention study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Timely recognition and referral of patients with spondyloarthritis (SpA) is challenging due to the frequent unawareness of the clinical picture.

Aim

To identify clinical assessment patterns of GPs and GP-residents when facing a patient suspected of having SpA, and to determine which components of clinical assessment were most prevalent prior to referral to the rheumatologist and whether targeted education could positively influence pattern recognition.

Design & setting

Prospective multicentre educational intervention study in primary care practices in the Netherlands.

Method

GPs and GP-residents were visited in two rounds by standardised patients (SPs) simulating axial or peripheral SpA (dactylitis). Between these rounds, an educational intervention regarding SpA took place for part of the participants. SPs completed a case-specific checklist inquiring about disease-related items and items on physical examination.

Results

Sixty-eight participants (30 GPs and 38 GP-residents) were included and 19 (28%) received the educational intervention. In round 1, about half of the participants asked at least one question to differentiate between an inflammatory or mechanical origin of the back pain or peripheral complaint; on average, <15% asked for extra-articular manifestations. After education, GP-residents inquired more about the presence of extra-articular manifestations and family history of axial SpA; this pattern was also observed in the GPs and GP-residents who correctly referred the SP. In the peripheral SpA case, the observed gain was less evident when compared to the axial SpA case.

Conclusion

Pattern recognition of patients suspected for SpA by GP(-residents) is essential for referral to a rheumatologist and can be improved by education.

Related collections

Most cited references 14

Record: found
Abstract: found
Article: not found

Measuring disease prevalence: a comparison of musculoskeletal disease using four general practice consultation databases.

Peter Croft, Thomas A. Clarke, D P M Symmons … (2006)

Primary care consultation data are an important source of information on morbidity prevalence. It is not known how reliable such figures are. To compare annual consultation prevalence estimates for musculoskeletal conditions derived from four general practice consultation databases. Retrospective study of general practice consultation records. Three national general practice consultation databases: i) Fourth Morbidity Statistics from General Practice (MSGP4, 1991/92), ii) Royal College of General Practitioners Weekly Returns Service (RCGP WRS, 2001), and iii) General Practice Research Database (GPRD, 1991 and 2001); and one regional database (Consultations in Primary Care Archive, 2001). Age-sex standardized persons consulting annual prevalence rates for musculoskeletal conditions overall, rheumatoid arthritis, osteoarthritis and arthralgia were derived for patients aged 15 years and over. GPRD prevalence of any musculoskeletal condition, rheumatoid arthritis and osteoarthritis was lower than that of the other databases. This is likely to be due to GPs not needing to record every consultation made for a chronic condition. MSGP4 gave the highest prevalence for osteoarthritis but low prevalence of arthralgia which reflects encouragement for GPs to use diagnostic rather than symptom codes. Considerable variation exists in consultation prevalence estimates for musculoskeletal conditions. Researchers and health service planners should be aware that estimates of disease occurrence based on consultation will be influenced by choice of database. This is likely to be true for other chronic diseases and where alternative symptom labels exist for a disease. RCGP WRS may give the most reliable prevalence figures for musculoskeletal and other chronic diseases.

0 comments Cited 71 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Scientific contributions of ankylosing spondylitis patient advocacy groups.

Arshad Khan, J Brückel, E Feldtkeller (2000)

The Spondylitis Association of America has been the driving force behind a major research initiative in the US, having leveraged a substantial amount of money into a $4.5 million grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The grant last year established the North American Spondylitis Consortium to expedite the search for genes that determine susceptibility to ankylosing spondylitis. The German Ankylosing Spondylitis Society, which has more than 14,000 patient members, initiated in 1996 a professional survey of ankylosing spondylitis patients, with financial support from the German Federal Health Ministry. The results of this survey have recently been published, but only in the German language; a part of it is summarized here in English. Following are some of the important findings. The average age at disease onset does not differ significantly between men and women, but there is a significantly longer delay in disease diagnosis among female patients. The average delay in disease diagnosis is getting shorter; there was an average delay of 15 years for patients with disease onset in the 1950s, and it decreased to 7.5 years for patients with disease onset between 1975 and 1979. There was a relatively greater degree of underdiagnosis of the disease among female than male patients in the past; whereas only 10% of the patients in whom the disease was diagnosed in about 1960 were women, this percentage has progressively increased in the subsequent decades to reach 46% among those in whom the disease was diagnosed since 1990. The speed at which spinal ankylosis progresses is slower in female patients, but women are in a significantly worse situation than men in terms of pain and the need for drug therapy, even though the women in the German Ankylosing Spondylitis Society sample are, on average, younger than the men and have a shorter average disease duration. It is possible that the slower and relatively incomplete progression to spinal ankylosis in female patients impedes the occurrence of a decrease in pain with time, compared with that observed in male patients.

0 comments Cited 39 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Educational deficiencies in musculoskeletal medicine.

K Freedman, Joseph Bernstein (2002)

We previously reported the results of a study in which a basic competency examination in musculoskeletal medicine was administered to a group of recent medical school graduates. This examination was validated by 124 orthopaedic program directors, and a passing grade of 73.1% was established. According to that criterion, 82% of the examinees failed to demonstrate basic competency in musculoskeletal medicine. It was suggested that perhaps a different passing grade would have been set by program directors of internal medicine departments. To test that hypothesis, and to determine whether the importance of the individual questions would be rated similarly, the validation process was repeated with program directors of internal medicine residency departments as subjects. Our basic competency examination was sent to all 417 program directors of internal medicine departments in the United States. Each recipient was mailed a letter of introduction explaining the purpose of the study, a copy of the examination, and our answer key and scoring guide. There was no mention of the results of the first study. The subjects were requested to rate the importance of each question on the same visual analog scale, ranging from "not important" to "very important," as had been used by the orthopaedic program directors. These ratings were converted into numerical scores. The program directors were also asked to suggest a passing score for the examination, and this score was used to assess the examinees' performance on the examination. The results on the basis of the internal medicine program directors' responses and those according to the orthopaedic program directors' responses were compared. Two hundred and forty (58%) of the 417 program directors of internal medicine residency departments responded. They suggested a mean passing score (and standard deviation) of 70.0% +/- 9.9%. As reported previously, the mean test score of the eighty-five examinees was 59.6%. Sixty-six (78%) of them failed to demonstrate basic competency on the examination according to the criterion set by the internal medicine program directors. The internal medicine program directors assigned a mean importance score of 7.4 (of 10) to the questions on the examination compared with a mean score of 7.0 assigned by the orthopaedic program directors. The internal medicine program directors gave twenty-four of the twenty-five questions an importance score of at least 5 and seventeen of the twenty-five questions an importance score of at least 6.6. According to the standard suggested by the program directors of internal medicine residency departments, a large majority of the examinees once again failed to demonstrate basic competency in musculoskeletal medicine on the examination. It is therefore reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.

0 comments Cited 38 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): BJGP Open

Journal ID (iso-abbrev): BJGP Open

Journal ID (publisher-id): bjgpoa

Journal ID (hwp): bjgpoa

Title: BJGP Open

Publisher: Royal College of General Practitioners (London )

ISSN (Electronic): 2398-3795

Publication date (Electronic, pub): 09 January 2017

Publication date Collection: April 2017

Volume: 1

Issue: 1

Electronic Location Identifier: bjgpopen17X100689

Affiliations

[1 ]deptRheumatologist, Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, and School for Public Health and Primary Care (CAPHRI) , Maastricht University Medical Center , Maastricht, the Netherlands

[2 ]deptRheumatologist, Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, and School for Public Health and Primary Care (CAPHRI) , Maastricht University Medical Center , Maastricht, the Netherlands

[3 ]deptGP, Department of General Practice , Maastricht University , Maastricht, the Netherlands

[4 ]deptGP, Department of General Practice , Maastricht University , Maastricht, the Netherlands

[5 ]deptRheumatologist, Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, and School for Public Health and Primary Care (CAPHRI) , Maastricht University Medical Center , Maastricht, the Netherlands

Author notes

*For correspondence: m.van.onna@ 123456mumc.nl

Article

Publisher ID: 00689

DOI: 10.3399/bjgpopen17X100689

PMC ID: 6172669

SO-VID: a45b2c0e-5cfa-46b8-9457-77b7de114294

License:

This article is Open Access: CC BY-NC 4.0 license ( https://creativecommons.org/licenses/by-nc/4.0/)

GPs’ patterns of clinical assessment when faced with a patient suspected for spondyloarthritis: a prospective educational intervention study

Read this article at

Abstract

Background

Aim

Design & setting

Method

Results

Conclusion

Related collections

Chinese Journal of General Practice

Most cited references 14

Measuring disease prevalence: a comparison of musculoskeletal disease using four general practice consultation databases.

Scientific contributions of ankylosing spondylitis patient advocacy groups.

Educational deficiencies in musculoskeletal medicine.

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 518

Cited by 2

Most referenced authors 155