Background Although consistent divulgation and training US initiatives have been underway nationwide, the number of ultrasound (US) machines and experienced examiners in Brazil is inadequate for covering the country demand. There are 36 machines used by rheumatologists, mostly in the southeast, for a population of approximately 800,000 rheumatoid arthritis (RA) patients. Clearly there are barriers to US dissemination that could be related to the acceptance of the method or practical barriers such as machine cost and reimbursement.
Objectives To get insights on the barriers and unmet needs in Brazil in order to define Targeted-Ultrasound Initiative (TUI -educational program aimed to promote greater use of ultrasound in the management of rheumatoid arthritis) strategies.
Methods A web-based questionnaire about US practice and basic concepts was developed and distributed to members of the Brazilian Society of Rheumatology (BSR).
Results Among 2.206 BSR active members, 249 rheumatologists from all over the country answered the questionnaire, roughly following the allocation pattern of the rheumatologists in the country. Interestingly, 37,8% of the responders graduated after 2000 and 45,8% between 1981 and 2000. About half of them had never participated in an US course (51%), but only 8.8% reported no interest in learning. Access to US was prevalent but mostly through a radiologist (72.3%), with no specific training in rheumatology. Most rheumatologists supported US value in diagnosis (90.4%) and treatment follow up (78.7%) as well as in treatment guidance (87.9%), contributing to indicate treatment changes in inflammatory arthropathies. On the other hand, US was recognized as useful tool for erosion assessment by only 59% of the rheumatologists. Regarding barriers, the limited access to machines and reimbursement issues were mentioned respectively by 52.7 and 32% of the rheumatologists but surprisingly the lack of continuous and supervised practice necessary to the learning process and proper qualification was considered an important barrier by 66%.
Conclusions Most rheumatologists understand the importance of US and its value in improving patient outcomes. This recognition of US usefulness could be interpreted a result of the divulgation and training initiatives. The significant barriers were not only related to cost (machine vs. reimbursement) but to the practical aspects of the learning process and adequate qualification; the most pressing unmet needs hence identified.
Ann Rheum Dis 2012;71:6799-803.
Disclosure of Interest None declared