A general practice perspective on early rheumatoid arthritis management: A qualitative study from Flanders

ABSTRACT

Background: General practitioners (GPs) may play a crucial role in early recognition, rapid referral and intensive treatment follow-up of patients with rheumatoid arthritis (RA). To improve early RA management, perceived barriers in general practice must be addressed. However, the general practice perspective on early RA management remains understudied.

Objective: To explore GPs’ experiences, beliefs and attitudes regarding detection, referral, and intensive treatment for early RA.

Methods: In 2014, a qualitative study was conducted by means of individual, in depth, face-to-face interviews of a purposive sample of 13 Flemish GPs. Interviews were audio-recorded, transcribed verbatim and coded using the constant comparative method.

Results: GPs applied multiple assessment techniques for early RA detection and regularly prescribed non-steroidal anti-inflammatory drugs if they suspected early RA. However, GPs felt unconfident about their detection skills because early RA symptoms are often unclear, diagnostic tests could provide inconclusive results and the incidence is low in general practice. GPs mentioned various approaches and multiple factors determining their referral decision. Perceived referral barriers included limited availability of rheumatology services and long waiting times. GPs considered intensive treatment initiation to be the expertise of rheumatologists. Reported key barriers to intensive treatment included patients’ resistance and non-adherence, lack of GP involvement and unsatisfactory collaboration with rheumatology services.

Conclusion: GPs acknowledge the importance of an early and intensive treatment, but experience various barriers in the management of early RA. GPs should enhance their skills to detect early RA and should actively be involved in early RA care.

Key words:

• Arthritis
• rheumatoid
• general practice
• qualitative research

ACKNOWLEDGEMENTS

The authors thank the GPs who participated in this study for their time and openness during the interviews.

FUNDING

This study was supported by a grant from the Fonds voor wetenschappelijk reumaonderzoek/Fonds pour la recherche scientifique en rhumatologie. Patrick Verschueren is the holder of the Pfizer chair for early rheumatoid arthritis management at the KU Leuven and is supported by the Clinical Research Foundation of UZ Leuven, Belgium.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.