Primary Care in rheumatoid arthritis

Abstract

Background:<br />General practitioners (GPs) have an important role in early diagnosis, treatment, and referring rheumatoid arthritis (RA) patients. Many patients didn't receive rheumatologist care on appropriate time. Therefore, it seems necessary to evaluate GPs' knowledge and attitude about RA to identify some of the barriers in the optimal care of patients with RA delivered by GPs.<br />Methods: 120 GPs who were selected through simple and non-random sampling from physicians participating in 5 educational seminars which were held in Tehran. The survey questioned their confronting with RA, experience with prescribing disease-modifying anti-rheumatic drugs (DMARDs) and referral to the rheumatologist.<br />Results:<br />28.3% of GPs had no RA patients monthly. 35.8% declared that they visit 3-5 RA patients per month on average. 95 out of 120 (79.2%) referred RA to a rheumatologist as soon as possible. Physicians' knowledge sources about rheumatoid arthritis were mostly general medical training (87.5%). 47.5% had low and 5% lacked self-esteem in managing RA patients. 92.5% of GPs were familiar with DMARDs but 22.1% of them have been ordered them. Lack of knowledge about the side effects of DMARDs was the main reason for hesitance to prescribe them. Also, we found being older, male and more experienced GPs are more comfortable in managing RA patients.<br />Conclusion:<br />RA care delivered by GPs was not consistent with current treatment guidelines focusing on early DMARDs therapy. GPs do not have enough information and confidence in managing patients with RA. Improving physicians' knowledge and continued educational programs are suggested.