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Abstract Number: 96

Quality of Care: Reference and Counter Reference From Family Physicians and Rheumatologists’ perspectives– A Pilot Study

Thiago D. Baumgratz1, Raphael Battisti1, Mirella Cuziol2, Ana Carolina Reiff Janini2, R.A. Levy3 and Mirhelen M. Abreu4, 1Medical Student at Universidade Federal de São Carlos, São Carlos, Brazil, 2Medicine, Medical Student at Universidade Federal de São Carlos, São Carlos, Brazil, 3Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil, 4Universidade Federal de São Carlos, São Carlos SP, Brazil

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Assessment, Clinical practice guidelines, decision analysis and quality of care, Public Health Approach

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Session Information

Title: Epidemiology and Health Services Research: Epidemiology and Outcomes of Rheumatic Disease I

Session Type: Abstract Submissions (ACR)

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.


Disclosure:

T. D. Baumgratz,
None;

R. Battisti,
None;

M. Cuziol,
None;

A. C. R. Janini,
None;

R. A. Levy,
None;

M. M. Abreu,
None.

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