Session Information
Date: Monday, November 14, 2016
Session Title: ARHP III: Education and Community Programs
Session Type: ARHP Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Primary and emergency care providers may have received 45 minutes of lupus education in medical school. Providers may fail in recognizing lupus because symptoms are often vague, delaying referrals and diagnosis for 2-6 years. Delay can lead to accrual of organ damage and death, which is more prevalent in minority populations. Many patients are referred to rheumatology not meeting assessment criteria for lupus, creating barriers to rheumatology care for urgent patients. The goal of LEAP is to increase lupus knowledge and improve lupus assessment and referral procedures among primary and emergency providers within the healthcare system.
Methods : LEAP enlisted rheumatology fellows to serve as educators to deliver a 1 Continuing Medical Education credit seminar. Four sites were selected based on commitment from Rheumatology Fellowship Program Directors or previous experience with the Teaching Fellows in Lupus Project, after which LEAP was modeled. Sites identified a problem in lupus referrals and included ways to address the problem in the seminar. Examples of problems in referrals that were addressed in the seminar include 1) ANA titer not included in the referral; 2) patients referred with only a positive ANA and no relevant clinical symptoms included; 3) consults with rheumatology conducted prior to issuing a formal referral. Rates will be analyzed to assess if the seminar changed behavior. Voluntary, anonymous pre/post assessments were used to evaluate changes in knowledge and behavior and collect qualitative data. A t-test was used to analyze independent group means.
Results: Preliminary data from 427 assessments were analyzed on a 9-point scale. Total mean score increased 2.10 immediately post seminar and 2.88 points at 4-6 weeks post seminar (p<.01). Over 85% reported the 1) activity improved medical or practice knowledge and 2) they would make changes that will benefit patient care. Respondents are considering lupus more at 4-6 weeks post seminar.
Conclusion: Rheumatology fellows can increase knowledge and promote behavior change in lupus assessment and referral among primary and emergency providers. LEAP may be an effective strategy to reduce health disparities in lupus.
| Table 1. Knowledge Change Pre/Post/4-6 Weeks Post Seminar | ||||
| Assessment (Group Data) |
N |
Mean Score (SD) |
Mean Score Change from Pre Assessment |
P-Value |
| Pre Seminar |
208 |
5.07 (2.38) |
n/a |
<.01 |
| Post Seminar |
199 |
7.17 (1.45) |
2.10 |
<.01 |
| 4-6 Weeks Post Seminar |
20 |
7.95 (1.90) |
2.88 |
<.01 |
| Table 2. Sustained Behavior Changes | ||
| Matched Assessments Pre to 4-6 Weeks Post |
N=15 |
|
| Question |
Pre % |
4-6 Weeks Post % |
| 1) You consider lupus in your differential diagnosis during an exam? | ||
| Very Often |
0 (0.0) |
11 (73.3) |
| Somewhat Often |
3 (20.0) |
3 (20.0) |
| Not Very Often |
1 (6.7) |
1 (6.7) |
| Not At All |
11 (73.3) |
0 (0.0) |
| 2) You refer patients to the rheumatologist for suspected lupus? | ||
| Extensively |
1 (6.7) |
12 (80.0) |
| Significantly |
0 (0.0) |
1 (6.7) |
| Occasionally |
3 (20.0) |
1 (6.7) |
| Seldom |
0 (0.0) |
1 (6.7) |
| Never |
11 (73.3) |
0 (0.0) |
| 3) You refer patients to lupus educational material or other educational resources? | ||
| Always |
0 (0.0) |
11 (73.3) |
| Often |
0 (0.0) |
1 (6.7) |
| Occasionally |
0 (0.0) |
1 (6.7) |
| Rarely |
3 (20.0) |
2 (13.3) |
| Never |
12 (80.0) |
0 (0.0) |
To cite this abstract in AMA style:
Gross D, Caron A, Blanco I, Denio A, Desai S, Sammut A, Naqvi Z. Lupus Education Advancement Project (LEAP): Rheumatology Fellows Serving As Educators Increased Knowledge and Efficiency in Lupus Recognition and Referral By Providers in Primary and Emergency Care [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/lupus-education-advancement-project-leap-rheumatology-fellows-serving-as-educators-increased-knowledge-and-efficiency-in-lupus-recognition-and-referral-by-providers-in-primary-and-emergency-care/. Accessed September 17, 2019.« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/lupus-education-advancement-project-leap-rheumatology-fellows-serving-as-educators-increased-knowledge-and-efficiency-in-lupus-recognition-and-referral-by-providers-in-primary-and-emergency-care/