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OP0253-PC Training for general practitioners: Does an education program and a diagnostic algorithm improve referral reliability?
  1. Y. El Miedany1,
  2. M. El Gaafary2,
  3. S. Youssef1,
  4. D. Palmer3
  1. 1Rheumatology and Rehab
  2. 2Community, enviromental and Occupational Medicine, Ain Shams University, Cairo, Egypt
  3. 3Rheumatology, North Middlesex University Hospitals, London, United Kingdom

Abstract

Background Whilst deficiencies in undergraduate rheumatology training may have, negatively, influenced the competence of general practitioners in dealing with musculoskeletal complaints, postgraduate education is likely to be even more crucial, whether as continuing medical education or as part of their vocational training. Local educational schemes provided by local rheumatologist with interest in medical education represent an “educational window” for training both the post-graduate as well as training general practitioners. It also raises their attention to the recent developments in the field of rheumatology and how to implement the new guidelines released into standard clinical practice.

Objectives To assess whether an education program and a referral algorithm can improve the reliability of referral behavior to the early arthritis (EA) clinic. Also to assess the impact of this educational activity on the patients’ management and the service provided.

Methods An educational activity was launched in parallel with the setting up of a specialized early arthritis clinic. The target was to educate and train GPs to identify a subgroup of patients suffering from persistent joint pains suggestive of EA. The organized teaching program revived the local release scheme educational activity. All GPs received summarized guidelines for case definition and referral to the clinic as well as the clinic alogorithm for assessment and management of EA. Teaching adopted the problem based learning approach.Primary outcome: To assess whether an education program and a referral algorithm can improve reliability of referral behavior to the early arthritis clinic. Secondary outcome: 1. To assess whether there has been a change of the referral distribution of patients to the clinic per year reflected by the prevalence of inflammatory arthritis as a final diagnosis among the patients referred to the clinic over 3-years period (from 2008 till 2010/2011). 2. The impact of this development on the patients’ management as well as the service provided.

Results A proper educational program was reliable (Cronbach’s alpha 0.87) and valid for identifying patients suffering from EA. There has been a steady and significant (p<0.01) increase in the number of the patients referred and assessed in the EA clinic. Analysis of the referral distribution revealed also a significant shift in the range of diagnoses over time. On comparing the year 2010 to the years 2009 and 2008, assessment of the number of diagnosis in time for each standard diagnosis registration category revealed a significant increase (p<0.01) of the EA as a definite final diagnosis, matching the GPs initial diagnosis of inflammatory arthritis, when the patient was first referred to the clinic. In response to the positive impact of the educational activity, the rheumatology department invested more, both in time and resources. More time was dedicated for the clinic and Musculoskeletal US was introduced to set up a one stop early arthritis clinic.

Conclusions The GPs performance and the referral pattern can be improved significantly by an appropriate education program. Local educational schemes provided by rheumatologist with interest in medical education represent an “educational window” for training both the post-graduate as well as training general practitioners.

Disclosure of Interest None Declared

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