Background Good Medical Practice for General Practitioners 1and RCGP Curriculum 2010 2 has provided comprehensive and holistic guidance for high standard of patient care. GPs are expected to have an adequate knowledge about various specialties. Chronic low back pain is one of the commonest musculoskeletal presentations in primary care. Around 6% of adults suffer from chronic back pain in UK, and 5% amongst them suffer from Inflammatory back pain (IBP).3 Previous studies from UK shown a delay in diagnosis of IBP up to 8years. It is essential that GP trainees acquire adequate training in managing IBP.
Objectives 1) To explore the knowledge of GP trainees in management of chronic back pain.
2) To assess the knowledge of GP trainees in diagnosis and management of inflammatory back pain.
Methods This is an observational questionnaire based survey. The designed questionnaires were initially piloted locally, redesigned later and distributed online across to East Midland GP trainees and during the GP educational study days. Data was collected and analysed using the online data manager, smart survey®.
Results Total responders were n=80. 58% of trainees were at their third year or higher level of training. In a working week, 61% of respondents review 5-10 patients with chronic back pain. More than 50% of trainees were very confident in assessing mechanical back pain (MBP) and only 12% in IBP. 74% of GPTrainees were confident in eliciting adequate history for diagnosis of MBP only 38% for IBP. More than 90% of trainees were satisfied with their undergraduate, foundation training for MBP and only 15% of trainees with IBP.
For patients with IBP, 25% of respondents did not prefer specialist referral and 63% were unaware of AS speciality clinic in Leicestershire. More than 70% of them reviewed their patients 2-4 times and 18% more than 5 times before referring to specialist care. Only 16% were aware of national statistics about delay in referral of AS patients to specialist care.
Comparatively there was more confidence in investigating patients of MBP ((78%) and only 26% for IBP. More than 90% of respondents would like to request HLAB27 for their IBP patients. 73% preferred radiograph of SI joint and spine over MRI scan of Spine (60%) for IBP.
More trainees were very confident in treating MBP (72%) compared to only 24% for treating IBP. Amongst patients with IBP, 41% received NSAIDs, 27% have been referred to physiotherapy. Only 14% of respondents were aware of TNF blockers as a treatment option.
Conclusions This study has highlighted relative lack of confidence among GP trainees in the assessment and management of inflammatory back pain compared to mechanical back pain. Inflammatory back pain focussed training is essential part in the GP training.This could be achieved either through web based learning or formal rheumatologist lead training sessions on inflammatory back pain.
General Practitioners Committee of the BMA and the Royal College of General Practitioners. Good Medical Practice for General Practitioners London: RCGP, 2008.
RCGP Curriculum 2010, revised 14 August 2013: Care of People with Musculoskeletal Problems.
McKenna, F. Spondyloarthritis. Reports on the Rheumatic Diseases 2010;6(5):1-6.
Disclosure of Interest None declared