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THU0507 Is there a Knowledge Gap in Diagnosing Inflammatory Back Pain in Primary Care? - Regional Survey Among GPs in Leicestershire, UK
  1. A. Moorthy1,
  2. C. Joseph1
  1. 1Rheumatology, University Hospitals of Leicester NHS trust, Leicester, United Kingdom

Abstract

Background Ankylosing sponylitis (AS) is an under-recognised inflammatory condition affecting 200 000 young men and women in the UK. It mostly affects young men before the age of 40 years. Current evidence indicates an average delay in diagnosis of 10 years from symptom onset. One-third of patients are not reviewed in secondary care. Recent UK studies (1) show approximately 8.57 years in delay of diagnosis. The decreased awareness of this condition amongst the general public and primary care physicians could be a key factor in the delay. As the symptoms improve with physical activity, few patients among this age group present to their GP at an early stage, which further delay the diagnosis and management.

Objectives

  • To explore the Primary care physicians knowledge in evaluating Back pain (BP) particularly inflammatory back pain (IBP)

  • To identify the current practice in diagnosing and managing inflammatory back pain in community

  • To explore the interest in Primary care about further education on IBP

Methods This is a prospective questionnaire based study. The questionnaire has been developed addressing the key factors in the diagnosis of Mechanical back pain (MBP) and inflammatory back pain (IBP), which was piloted locally. The redesigned questionnaire was electronically circulated to GPs practicing across the Leicestershire County. The results were then analysed using excel spreadsheet.

Results The total number of respondents N= 151. Most of the GPs (58%) were with more than 15years of clinical experience. As shown in previous studies BP is the common symptom for primary care consultation and most of the Gps (57%) see more than 10 patients with BP symptom It is interesting to note the gender distribution which is equal both men and women Among BP patients they see 85%are due to MBP and 15% due to IBP. (76%) respondents observedIBP in less than 40 yrs of age group and MBP in older age group. 56% Gps are very confident in diagnosing MBP and only 35% are confident in diagnosing IBP.when explore the knowledge further we asked to rate the symptom suggestive of IBP in a scale of 1-10 Early morning stiffness rated 7.8 and improvement with exercise6.8 alternating buttock pain 5.47. While asking the most important investigations they perform for IBP Inflammatory marker came on top as97% comparing MRI of sacroiliac Joint is requested only by 33%. Average 3 visit by a patient to GP before a referral to Secondary care is made and the average delay is 9 months noted. It is observed GPs are very keen to get further education on IBP and prefer practical sessions and web based teaching.

Conclusions This is the first study of its kind conducted in our county exploring the Primary Care knowledge in comparing IBP and BP. With a good number (n=151) we can derive a meaningful conclusion locally about the understanding and current practice. Gps are confident in diagnosing and managing MP however less confident in IBP. Though some diagnosing IBP they delay referral to specialist due to lack of knowledge. Further education is essential in raising the awareness among GP in diagnosing IBP early and prompt specialist referral for appropriate management.

References

  1. Services for people with ankylosing spondylitis in the UK—a survey of rheumatologists and patients

    Louise Hamilton et al Rheumatology (2011) 50(11): 1991-1998

Disclosure of Interest A. Moorthy Grant/research support from: ABBOTT, C. Joseph: None Declared

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