Primary care physician perspectives on screening for axial spondyloarthritis: A qualitative study
Authors
Lapane, Kate L.Shridharmurthy, Divya
Khan, Sara
Lindstrom, Daniel
Beccia, Ariel
Yi, Esther
Kay, Jonathan
Dube, Catherine E.
Liu, Shao-Hsien
UMass Chan Affiliations
Division of Rheumatology, Department of MedicineGraduate Medical Education, Internal Medicine
Clinical and Population Health Research Program, Graduate School of Biomedical Sciences
Division of Epidemiology, Department of Population and Quantitative Health Sciences
Document Type
Journal ArticlePublication Date
2021-05-24Keywords
UMCCTS fundingaxial spondyloarthritis
screening
primary care physicians
Diagnosis
Musculoskeletal Diseases
Primary Care
Rheumatology
Translational Medical Research
Metadata
Show full item recordAbstract
BACKGROUND: Many patients with axial spondylarthritis (axSpA) experience lengthy diagnostic delays upwards of 14 years. (5-14 years). Screening tools for axSpA have been proposed for use in primary care settings, but whether this approach could be implemented into busy primary care settings remains unknown. OBJECTIVE: To solicit feedback from primary care physicians regarding questions from the Inflammatory Back Pain Assessment: the Assessment of Spondyloarthritis International Society (ASAS) Expert Criteria and gain insight about barriers and facilitators for implementing axSpA screening in primary care. METHODS: Guided by Consolidated Criteria for reporting Qualitative Research (COREQ-criteria), we recorded, transcribed, and analyzed in-depth interviews with eight family medicine physicians and ten internists (purposeful sampling) using immersion/crystallization techniques. RESULTS: Few physicians reported awareness of existing classification criteria for axSpA, and many reported a lack of confidence in their ability to distinguish between inflammatory and mechanical back pain. From three domains, 10 subthemes emerged: 1) typical work-up of axSpA patients in primary care, with subthemes including the clues involved in work-up and role of clinical examinations for axSpA; 2) feedback on questions from the Inflammatory Back Pain Assessment: ASAS Expert Criteria, with subthemes to evaluate contents/questions of a potential screening tool for axSpA; and 3) implementation of the screening tool in primary care settings, with subthemes of perceived barriers including awareness, time, other conditions to screen, rare disease, and lack of structured questionnaire for back pain and perceived facilitators including workflow issues and awareness. CONCLUSIONS: Primary care physicians believed that an improved screening instrument and a strong evidence-base to support the need for screening for axSpA are required. The implementation of axSpA screening into a busy primary care practice requires integration into the practice workflow, with use of technology suggested as a possible way to improve efficiency.Source
Lapane KL, Shridharmurthy D, Khan S, Lindstrom D, Beccia A, Yi E, Kay J, Dube C, Liu SH. Primary care physician perspectives on screening for axial spondyloarthritis: A qualitative study. PLoS One. 2021 May 24;16(5):e0252018. doi: 10.1371/journal.pone.0252018. PMID: 34029339; PMCID: PMC8143395. Link to article on publisher's site
DOI
10.1371/journal.pone.0252018Permanent Link to this Item
http://hdl.handle.net/20.500.14038/50419PubMed ID
34029339Related Resources
Rights
Copyright © 2021 Lapane et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Distribution License
http://creativecommons.org/licenses/by/4.0/ae974a485f413a2113503eed53cd6c53
10.1371/journal.pone.0252018
Scopus Count
Except where otherwise noted, this item's license is described as Copyright © 2021 Lapane et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.