Background/Purpose:

Developing countries face serious socioeconomics problems, and pediatric rheumatic illnesses are not seen as priority by health programs. The PANLAR Pediatric Rheumatology Study Group conducted a web based survey in order to assess the specific reality in Pediatric Rheumatology care in Latin America (LA), to gather individual data from all Pediatric Rheumatologists (PRs) in LA, their training history, practice, and characteristics of Juvenile Idiopathic Arthritis (JIA) patients as well as access to drug therapy and other health services.

Methods:

An international wide web based survey involving LA PRs. All performed a baseline evaluation, including 54 questions to assess in the following domains: demographics, practice status, training history, functional status of JIA and access to treatment and monitoring resources. Data captured began December 30, 2014 and closed on February 28, 2015.

Results:

A total of 169 (47%) responded to the survey sent to 356 PRs in LA, from Argentina, Bolivia, Brazil, Chile, Colombia, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Nicaragua, Paraguay, Peru, Puerto Rico, Dominican Republic, Uruguay, Venezuela. There were: 16 countries without PRs, all from Antilles and some countries of Central America. The largest number (68%) of PRs works in countries with larger populations and training centers as Argentina, Brazil, Colombia and Mexico. Forty five percent of PRs has been in practice for less than 10 years. Twenty percent of LA children are seen by a Rheumatologist untrained in Pediatrics. Most PRs work in urban areas and under the Public Health System. Of the total available time, 90% is spent in patient care and 10% in research. JIA subtypes distribution matches other series. The median time from the beginning of first symptoms to diagnosis was 6 (3-11) months in 50% of LA JIA patients. A Steinbrocker functional class III and IV was observed in 18% of patients at presentation. In almost 50% of countries, PRs are solo practitioners. Full adherense to treatment is around 61%; DMARDs requirement: 70%; Biologics use: 40%.  Access to biological therapy was graded as “very difficult” in 20% and covered by State or Social Security in 80%.

Conclusion:

The Survey data suggest a need to: 1. increase the number of pediatric rheumatologists, 2. Improve PR training, 3. Foster access to care, earlier referral and availability of effective medication. A cross sectional study of functional status in JIA is needed. With adequate funding PANLAR is well positioned to promote development of educational programs and to carry on epidemiologic prospective research.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pediatric-rheumatology-work-force-and-patients-status-in-latin-america-a-snap-shot-web-based-survey/