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

Figures & data

Table 1. Demographic characteristics of Flemish GPs interviewed (n = 13)^a.

	n (%)
Gender
Male	7 (54)
Female	6 (46)
GP practice type
Group practice	8 (62)
Single-handed practice	5 (38)
Degree of urbanization of GP practice location
Rural area	7 (54)
Urban area	6 (46)

GP: General Practitioner.

^aValues represent the absolute number of GPs.

Figure 1. Key findings of GPs’ experiences with early RA management.

Box 1. Questions included in the interview guide.

On average, what is the number of newly diagnosed patients with rheumatoid arthritis per year in your general practice? What have been your experiences in the detection of rheumatoid arthritis? In which circumstances is a patient referred to the rheumatologist? What have been your experiences with the patient referral process? How would you describe the patient referral process? What are the main difficulties regarding the detection and the patient referral? What is your opinion about an early and intensive treatment for rheumatoid arthritis combining one or more disease-modifying anti-rheumatic drugs with glucocorticoids in a step-down approach? In your opinion, what is the role of a general practitioner concerning the provision of an early and intensive treatment for patients with rheumatoid arthritis? To what extent is this role fulfilled in daily clinical practice? How would you describe the collaboration with other healthcare professionals? What are the main difficulties regarding an early and intensive treatment in general practice?

Box 2. Examples of comment transcripts of general practitioners’ experiences, beliefs and attitudes regarding early rheumatoid arthritis detection.

‘At the very first joint complaints, you will just give an NSAID of course, and then, if you see that it comes back or that it recurs, then we look further.’ (Quote 1—GP10) ‘If it is clinically obvious, with joint inflammation and joint swelling, then it will be easier of course. I think if that is not so clearly in the forefront, or maybe also if there is a clinical picture and then negative blood sample, then I think we will maybe also miss it sometimes, or that it takes longer before the diagnosis is finally made.’ (Quote 2—GP5) ‘Well, in former times we had our rheumatoid factor, but my lab more and more says now that this, more and more is abandoned actually and, that it is also apparently no longer an important test, thus I actually like it that you ask this question because I actually do not know anymore, how I have to diagnose rheumatoid arthritis at this moment.’ (Quote 3—GP3)

Box 3. Examples of comment transcripts of general practitioners’ experiences, beliefs and attitudes regarding early rheumatoid arthritis referral.

‘When there is insufficient result with treatment, or when the patient nonetheless has too explicit complaints, then he will be referred to a rheumatologist quite fast. So, I cannot really give a general idea, but I think that it is dependent on how the patient presents himself.’ (Quote 4—GP11) ‘Fifty per cent of rheumatologists does not send any report or still sends them with regular posting, so that they end up somewhere, god knows where in the file, so that you have to look them up every time. Thus, we give up those rheumatologists, and we continue working with the ones who cooperate. That is how it goes. That is the market.’ (Quote 5—GP10) ‘Yes, that is always exciting. I mean, that is about two or three times calling, waiting, I have a lot of patience, but the patients do not always have that much patience. Then, patients often say, “doctor, I will call myself,” and then, well, then it is very tempting to say “okay for me, go ahead.” And then, well, they eventually do not get where they have to be and then they call me back and I have to start all over again, that is a very common situation.’ (Quote 6—GP6)

Box 4. Examples of comment transcripts of general practitioners' experiences, beliefs and attitudes regarding intensive treatment initiation for early rheumatoid arthritis.

‘I’ve always got the message with rheumatism, to be fast enough and to treat fast enough, and not to wait, and then as soon as possible try to bring it under control, in the light of long-term effects and quality of life. But which choices [in treatment] are being made, that is not my business.’ (Quote 7—GP5) ‘Motivating to keep following the treatment, yes. And follow up, and monitoring the pain and functionality and, generally they see the rheumatologist only once or twice a year, so, it is our task to take care of the patients in general and to make sure they stick to the treatment, and to follow up their blood tests and stuff like that. And if they have some questions, that they can come to us with all their concerns.’ (Quote 8—GP8) ‘But another difficulty with early RA is the treatment I think. People if they are in pain they follow their treatment very well, but when the pain is over, then it becomes very difficult to make them take such medication as ledertrexate. It makes people sick.’ (Quote 9—GP8)