Background It cannot be said that all rheumatoid arthritis (RA) patients have sufficient access to the latest treatments for RA. In order to make the latest RA treatments available to a wider range of patients, it is essential to make progress with the co-management type of medical collaboration, in which patients are diagnosed by a rheumatology center, afterwards regular drug therapy are carried out with stable RA patients by primary care physicians and the patients are examined by visits to the rheumatology center at regular intervals. In Japan, primary care physicians include some with Rheumatology Board certification (RA-certified physicians), who often attend lecture courses to acquire more knowledge and understanding about RA. Specialist rheumatologists at rheumatology centers need to become more aware about primary care physicians’ attitudes to medical collaboration for managing RA patients.
Objectives A survey of primary care physicians’ attitudes to collaboration in RA treatment was carried out, and the results were analyzed to elucidate the differences between RA-certified and non-certified physicians.
Methods The survey was carried out on a questionnaire basis, with primary care physicians who attended lecture courses on RA. The χ2 test was used to analyze differences between RA-certified and non-certified physicians.
Results Responses were received from a total of 70 physicians. Two of these gave no response as to whether or not they had Rheumatology Board certifications, and the other 68 consisted of 19 RA-certified and 49 non-certified physicians. 89% and 76% of RA-certified and non-certified physicians, respectively, replied that they had the capability to accept following up RA patients, once stable control of arthritis had been achieved at a rheumatology center. Non-RA-certified physicians showed a greater tendency than RA-certified physicians to feel it to be difficult to accept patients who have been prescribed synthetic or biologic disease-modifying antirheumatic drugs. With respect to the appropriate interval between examinations at a rheumatology center of patients being followed by primary care physicians, the intervals most frequently stated by RA-certified and non-certified physicians were 6 and 3 months, respectively (p=0.039). In addition, non-RA-certified physicians were more likely than RA-certified physicians to feel uncomfortable about managing unstable RA symptoms and adjusting treatment strategies (p=0.035), whereas they were less likely to feel uncomfortable about managing RA complications and adverse effects of drugs (p=0.081).
Conclusions We found that, among primary care physicians, non-RA-certified physicians have considerable uncertainty and discomfort with managing RA patients, and their concerns about complications and adverse effects are limited. These findings are mainly due to primary care physicians not being sufficiently informed and enlightened about the paradigm shift in RA treatment. In order to establish co-management medical collaboration in which more patients receive the latest RA treatments, more vigorous education of primary-care physicians, especially non-RA-certified physicians, is needed by specialist rheumatologists at rheumatology centers.
Disclosure of Interest None Declared