primary care physicians perspectives towards managing rheumatoid arthritis room for improvement初级保健医生的视角对管理类风湿性关节炎改进的余地.pdfVIP

Garneau et al. Arthritis Research Therapy 2011, 13:R189 /content/13/6/R189 RESEARCH ARTICLE Open Access Primary care physicians’ perspectives towards managing rheumatoid arthritis: room for improvement 1 1,2 1 1,3* Katie L Garneau , Maura D Iversen , Hsun Tsao and Daniel H Solomon Abstract Introduction: Many people with rheumatoid arthritis (RA) do not receive care from a rheumatologist. We surveyed primary care physicians (PCPs) to better understand their attitudes, knowledge, and practices regarding the optimal treatment of RA. Methods: Randomly selected PCPs practicing in the US were surveyed. The survey encompassed their experience with RA, use of disease modifying anti-rheumatic drugs (DMARDs), and experience with rheumatology referrals. Logistic regression analyses described the responses and examined the correlation between physician variables and use of DMARDs. Results: E-mail invitations were opened by 1, 103 PCPs and completed by 267 (25%). Most respondents were men (68%) in practice for over 10 years (64%) who reported 6 or more RA patients under their care in the last year (71%). The majority reported some RA training after medical school (59%), but only one-third felt very confident managing this condition. Most (81%) reported prescribing DMARDs, but 37% do not initiate them, with only 9% reporting being very confident starting a DMARD. In unadjusted analyses, several respondent characteristics were strongly associated with not prescribing DMARDs, but none was significant after adjustment. Almost half (44%) of PCPs noted that patients report difficulty getting appointments with rheumatologists. Conclusions: We found many PCPs are uncomfortable managing RA with DMARDs, despite common beliefs that thei