Development of Focused Musculoskeletal Ultrasound Training for Primary Care Providers to Facilitate the Diagnosis of Gout: Initial Steps in an Educational Needs Assessment

Gary A. Kunkel¹, Andrea Barker², Jeremy Timm^3,4, Curry L. Koening⁵ and Michael J. Battistone⁶, ¹Division of Rheumatology, George Wahlen VA Medical Center/University of Utah, Salt Lake City, UT, ²Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, ³Salt Lake City VA Medical Center, Salt Lake City, UT, ⁴Internal Medicine, University of Utah, Salt Lake City, UT, ⁵Rheumatology, Division of Rheumatology, University of Utah, Salt Lake City, UT, ⁶Division of Rheumatology, Salt Lake City VA and University of Utah, Salt Lake City, UT

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Education, medical, medical education and musculoskeletal curriculum

Session Information

Date: Sunday, October 21, 2018

Title: Education Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Gout is common in primary care settings, though establishing or excluding the diagnosis with confidence can be challenging, particularly if arthrocentesis is not feasible at the time. Musculoskeletal ultrasound (MSK US) has emerged as a useful diagnostic tool, as identification of the double contour sign (DCS) is a rapid, relatively easy assessment that can help confirm the presence of gout. Although the practice of “point of care” ultrasound in several clinical conditions has expanded for some primary care providers (PCPs), the use of MSK US to specifically explore the diagnosis of gout remains largely associated with the subset of rheumatologists who have been trained in this technology. The purpose of our project was to contribute to a clinical and educational needs assessment, to inform the discussion and development of a potential training experience in MSK US for PCPs as well as health professions students and trainees at the Salt Lake City Veterans Affairs Medical Center (SLC VAMC) and University of Utah. Methods: All consult requests and appointments in the SLC VAMC Rheumatology MSK US clinic from May 2016 to May 2018 were identified, and those specifically addressing the diagnosis of gout were reviewed. Quality indicators relevant to access to care, including the time from the consult request to the clinic visit were also collected, as well as the origin of the consult request (e.g., rheumatology clinic vs. primary care; rural primary care vs non-rural primary care). Results: A total of 235 visits to the Rheumatology MSK US clinic were identified between May 2016 and May 2018; 52 (22%) of these included an evaluation for gout. Description of the gout MSK US visits is presented in Figure 1 and overall MSK US visits by type is presented in Figure 2. Out of the 52 patients for whom the visit included an evaluation for gout, 23 (44%) were confirmed.

Conclusion: Over 2 years, the availability in the MSK US clinic has been relatively unchanged, and is consistently near 30 days, a critical measure for VA health care systems. A substantial portion of these involve specific requests to consider the diagnosis of gout. As use of MSK US increases, there is likely to be a growing educational need within primary care. Rheumatologists should develop their role not only as content and technology experts in MSK US, but also as teachers for PCPs who are interested in learning how to perform and interpret this focused assessment to investigate the possibility of gout.

Disclosure: G. A. Kunkel, None; A. Barker, None; J. Timm, None; C. L. Koening, None; M. J. Battistone, ABIM Rheumatology Exam Committee, 9.

To cite this abstract in AMA style:

Kunkel GA, Barker A, Timm J, Koening CL, Battistone MJ. Development of Focused Musculoskeletal Ultrasound Training for Primary Care Providers to Facilitate the Diagnosis of Gout: Initial Steps in an Educational Needs Assessment [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/development-of-focused-musculoskeletal-ultrasound-training-for-primary-care-providers-to-facilitate-the-diagnosis-of-gout-initial-steps-in-an-educational-needs-assessment/. Accessed .

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