Are Spondyloarthropathies Adequately Referred From Primary Care to Specialized Care?

• Published in: Reumatología clinica (Barcelona) 2013-03, Vol.9 (2), p.90-93
• Main Authors: López-González, Ruth, Hernández-Sanz, Azucena, Almodóvar-González, Raquel, Gobbo, Milena
• Format: Article
• Language: English
• Subjects: Agreement; Atención primaria de salud; Concordancias; Criterios de derivación; Diagnóstico precoz; Early diagnosis; Esperanza Program; Espondiloartritis; Primary health care; Programa Esperanza; Referencia; Referral; Referral criteria; Spondyloarthritis
• ISSN: 2173-5743; 2173-5743
• DOI: 10.1016/j.reumae.2012.06.028

To evaluate the degree of agreement between primary care physicians and rheumatologists when evaluating the referral criteria in patients with suspected early spondyloarthropathy (Spa). Patients with suspected early Spa (according to predefined clinical referral criteria) were sent by primary care physicians to early Spa units (where a rheumatologist evaluated the same criteria and confirmed the diagnosis) through an on-line platform. We assessed the agreement between primary care physicians and rheumatologists regarding the predefined clinical refererral criteria among patients with definitive Spa using the kappa index (k). Eight hundred and two patients were analysed, 8.31% of whom were incorrectly referred to the rheumatologist. The degree of agreement regarding the predefined clinical referral criteria was poor for inflammatory back pain (k=0.16; 95% confidence interval [95% CI] 0.09–0.23), radiographic sacroiliitis (k=0.31; 95% 0.211–0.428), back or joint pain (k=0.21; 95% CI 0.14–0.29); mild for asymmetric arthritis (k=0.51; 95% CI 0.43–0.59), positive HLA B27 (k=0.59; 95% CI 0.52–0.67) and family history (k=0.50; 95% CI 0.415–0.604); and it was good or very good for anterior uveitis (k=0.81; 95% CI 0.68–0.93), inflammatory bowel disease (k=0.87; 95% CI 0.79–0.96) and psoriasis (k=0.73; 95% CI 0.65–0.81). The degree of agreement between primary care physicians and rheumatologists regarding the predefined clinical referral criteria was variable. Agreement was very poor for variables like inflammatory back pain, which are crucial for the diagnosis of Spa. Training programs for primary care physicians are important in order for them to correctly identify early Spa patients. Evaluar el grado de acuerdo entre los médicos de atención primaria (MAP) y los reumatólogos en la valoración de los criterios de derivación en pacientes con sospecha de espondiloartritis (EspA) precoz. Se derivaron los pacientes con sospecha de EspA precoz, a través de la plataforma electrónica, por MAP siguiendo unos criterios de derivación predeterminados a Unidades de EspA precoz, donde fueron de nuevo evaluados por reumatólogos y confirmados los diagnósticos. Se ha analizado la concordancia de los criterios de derivación predeterminados entre MAP y reumatólogos mediante el índice kappa (k) en aquellos pacientes con diagnóstico de EspA precoz. Analizamos 802 pacientes, de los que el 8,31% fueron mal derivados. El grado de acuerdo en relación con criterios de derivación predetermin