AB0890 Efficiency of 8-year educational programs for primary contact physicians in diagnosis and treatment of axial spondiloarthritis in kazan

Abstract

BackgroundIn recent years, there have been cardinal changes in terminology, understanding of pathogenesis of axial spondylitis (AxsSpA) and ankylosing spondylitis (AS), early diagnosis has improved. An important role is played by the level of awareness of primary care physicians in the early diagnosis of AxsSpA and AS.ObjectivesTo evaluate the effectiveness of educational activities for primary contact physicians in AxsSpA (including AS) diagnostics for a long time.MethodsFrom 2010 to the present time, educational activities are conducted for primary care physicians in diagnostics and tactics of managing patients with AS with discussion of the criteria for inflammatory back pain, options for onset and the algorithm for diagnosis and examination of patients with AxsSpA for primary contact physicians in Kazan. Since 2014, educational modules have been integrated into the system of continuing education of doctors. Assessment of the results of educational schools was carried out according to the analysis of reports of outpatient admission to rheumatologist of the City Rheumatological Centre in Kazan (Clinical Hospital # 7) and the analysis of medical records of patients sent to a rheumatologist in 2009 (base year) in comparison with 2010–2017 in the process of schools.ResultsIn the process of conducting schools (2010–2017) the number of patients with AxsSpA and AS significantly increased for the first time this year. In 2010–2011, the number of patients almost doubled (575 pts in 2010, 683 pts in 2011) compared to 2009 (378 pts). The second sharp increase in the number of patients was observed in 2016 (1178 pts) and in 2017 (1298 pts).The same dynamics was observed for AxsSpA patients (including AS) who applied for the first time to rheumatologist with a significant increase in patients in 2010–2011 (2009–118 pts, 2010–190 pts, 2011–204 pts) and in 2016–506 pts, 2017 year – 711 patients”Peak” increase in the number of patients in 2010–2011 can be explained by the beginning of educational activities for doctors; in 2016–2017 – an increase in the number of activities (including remote ones), the amount of information, increased availability of MRI examinations for patients with AxsSpA.Primary care physicians were more likely to refer patients with suspected AxsSpA or diagnosed AS, the percentage of discrepancies between diagnoses (referral and rheumatology) decreased from 78% in 2009 to 18.1% in 2011, 8.9% in 2013, 2.1% in 2015 and 3.3% in 2017.The number of patients coming from the primary contact physician to rheumatologist with the required volume of examination (description of back pain, laboratory tests, HLAB27 determination, radiographs and/or MRI) increased significantly from 23.7% in 2009 to 87% in 2017, which allows to verify diagnosis without repeated consultations.ConclusionsEducational programs for primary care physicians (lectures, schools, remote programs) have great importance for the timely diagnosis of AxsSpA, reducing the number of consultations before the diagnosis and with the subsequent appointment ...