Summary of results and effects of the state analysis on the Esperanza Program
| Result | Standards | SOPs | Performance indicators (standard) |
|---|---|---|---|
| ESPIDEP: Referral of patients with IBP and also with any BP or joint paint + SpA features did not produce massive referral of undefined symptoms | Referral criteria include BP or joint pain + SpA features | % of patients that fulfil Amor criteria of all referred correctly by the GP (>50%) | |
| ESPIDEP: SpA incidence 62.5 cases per 100 000 | In order to have enough patients to justify a separate clinic agenda, a referral area of 250 000 or more should be recommended. | ||
| SERAP: Contacting GPs who are referring poorly improves referral concordance | Responsibilities at the unit and at the PCC must be clearly identified.In addition to other methods, internet access to the programme should be assured in order to facilitate contact.Rheumatologists running the clinics must facilitate communication channels with the GPs | The platform measures the number of times a GP accesses a patient report.The platform automatically informs the GP about his performance on the referral criteria | % of patients referred according to the referral criteria in first visit from all attended (>50%) |
| SERAP: Short average waiting times at the rheumatology service are associated with compliance with referral criteria | The head of department must agree to the opening of a completely separate agenda based on the department's needs | ||
| QS: In order to improve GP participation, the processes should be simple, practical and official, without increasing the workload and guaranteeing confidentiality | The plan must have the signed approval of the primary care director | The referral procedures were kept simple (one-step referral, only one screen, embedded help) and direct access to the clinic agenda facilitated in the web platform.Confidentiality is assured in the platform | |
| QS: In order to improve GP participation, patient follow-up should have feedback at all times (including reports, recommendations on treatment, recommendations during sick leave, etc). | The web platform provides immediate feedback.GP has access to patient report in which there is a text field + automatic field for recommendations | Feedback guarantee: number of automatic reports browsed or downloaded by the GPs from the total number of reports generated at the unit (>85%) | |
| QS: In order to improve GP participation, the programme should provide GPs with a good training in SpA, preferentially accredited as CME | A calendar of meetings with the PCC should exist | Online course for GP training, divided into four modules of 3 h each (1.7 CME credits) |
BP, back pain; CME, continuing medical education; GP, general practitioner; IBP, inflammatory back pain; PCC, primary care centre; QS, qualitative study; SOP, standard operating procedure; SpA, spondyloarthritis.