Background/Purpose: Long-term outcomes in rheumatic diseases are impacted by their timely diagnosis, institution of correct treatment, management of complications and rigorous joint preservation strategies. The first point of contact in countries like India is the primary care physicians (PCP) who is either a general physician or an orthopaedician. Therefore, we designed this study to assess their knowledge base about various aspects of RA management and to show if this knowledge base could be improved by giving a short information course.The aim of the study is to develop, validate and assess the performance of a self-prepared questionnaire for assessing PCP’s knowledge about managing various aspects of RA and to use this tool to assess the impact of an information course in improving the above-mentioned elements among them.

Methods: A self-prepared questionnaire (in English) containing 29 multiple choice or true-false type questions with single correct answer assessing PCP’s knowledge about RA in 3 domains (a. etiology, disease process, signs & symptoms b. drug therapy & monitoring c. joint protection, exercise, coping) was prepared. All questions had an item-level content validity index (I-CVI) of at least 0.9. The scale-level content validity index based on the universal agreement method (S-CVI/UA) was 0.8 for the whole questionnaire as assessed by 6 experts. All questions had an option of ‘I don’t know’ which would prevent them from guessing the answer from the available options. Each question was given a score of 1 if answered correctly. The questionnaire was applied 2 times: at baseline and immediately after an information course to see the immediate impact. Information on the PCP’s experience with treating RA and their specialty was also collected. Frequency data were compared using McNemar test for paired nominal data & kappa statistics for ordinal data. Student’s paired t-test was used for comparison of mean scores to see the impact.

Results: At baseline, the questionnaire was applied to 293 PCPs (General Physicians: Orthopedicians = 81.2:18.8) and the mean(±SD) score was modest (16.68±6.027). Among these, 76 PCPs recorded a response after the information course. The option ‘I don’t know’ was exercised 998 times (11.74%) before the information course which reduced to 127 (5.76%) times after the course.After the information course, 26 out of 29 questions recorded a higher absolute number of correct responses than before the course. This increase in 20 out of 29 questions achieved statistical significance (Table–1). The mean(±SD) score for the questionnaire improved from 16.68(±6.027) to 22.2(±7.17) (p< 0.001) (Table-1).The scores before the information course were significantly different among general physicians and orthopedics. However, after the information course, no difference was noted among their scores, which suggests that the information course was equally effective for PCPs from both specialties.

Conclusion: Indian PCPs have a modest knowledge base about various aspects of RA management which can be improved significantly by short information course. The information course is equally effective irrespective of their specialization background.

Table – 1 Question-wise assessment of responses before and after the information course and the statistical significance of the change  

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/development-validation-and-performance-of-a-questionnaire-for-assessing-the-knowledge-base-of-primary-care-physicians-about-management-of-rheumatoid-arthritis-and-impact-of-an-information-course/