Background/Purpose: We delineated family physicians’ and rheumatologists’ point of view when primary care is facing cases of rheumatic diseases. We also tried to identify barriers in the reference and counter reference.

Methods: This is a pilot study, transversally designed, with family physicians and rheumatologists in a single city. The methodological steps were: (1) Development and preparation of three clinical scenarios that simulate and address different levels of clinical severity; (2) application of these scenarios in the population of family physicians and rheumatologists; (3) validation of the study scenarios. The final scenarios constructed were: (a) Scenario one: a patient with an autoimmune disease diagnosis presenting fever and fatigue; (b) Scenario two: a patient with fibromyalgia and with poor adherence to the healthcare plan, requiring a medication to relief the symptoms; (c) Scenario three: patient with septic arthritis, prostration, and in poor clinical conditions. The scenarios were presented to two groups of physicians, which should choose regarding three decisions: (Decision 1) To apply a healthcare plan (investigation and/ or treatment) and refer to a rheumatologist; (Decision 2) to prescribe medication and do not reference to rheumatologist; and (Decision 3) to refer to a rheumatologist with no primary care intervention. Finally, a multiple-choice questionnaire addressing potential factors that lead to barriers in the reference process of and counter reference was applied. Descriptive analysis was performed to map the results. As this was a pilot study, we used bootstrap method for constructing hypothesis tests.

Results: Twenty-two family physicians and rheumatologists were involved. Family physician’s initiative to refer to specialized care was similar to the rheumatologist’ expectation (median: 1.5 [minimum 1.5 to maximum 1.7], for family physicians and 1.6 [1.3 to 2] for rheumatologists). For Scenario one, the majority of interviewee chose Decision 1 [1.27 (1 –3), SD 0.59)]. For the Scenario two, respondents chose the decision 2 [2 (1 – 3), SD 0.76)]. For the Scenario three, Decision three was the preferred [1.47 (1 –3), SD 0.83)]. For the reference and counter-reference system evaluation, family physicians tend to refer any clinical case that could be a rheumatic disease. They consider that there is a poor communication between family physician and rheumatologist [4.2 (2 – 5), SD 1.01)].

Conclusion:  There is a tendency for referral to rheumatologists and a poor perception of risk. This posture can contribute to the quality of care impairment. Proper communication seems to be a hurdle for the reference and counter reference system.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/quality-of-care-reference-and-counter-reference-from-family-physicians-and-rheumatologists-perspectives-a-pilot-study/