Primary care physician perspectives on barriers to diagnosing axial Spondyloarthritis: a qualitative study
- PDF / 924,535 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 97 Downloads / 183 Views
RESEARCH ARTICLE
Open Access
Primary care physician perspectives on barriers to diagnosing axial Spondyloarthritis: a qualitative study Kate L. Lapane1,2* , Sara Khan1, Divya Shridharmurthy1,3, Ariel Beccia1,3, Catherine Dubé1, Esther Yi4, Jonathan Kay1,5,6 and Shao-Hsien Liu1,5
Abstract Background: The average delay in diagnosis for patients with axial spondyloarthritis (axSpA) is 7 to 10 years. Factors that contribute to this delay are multifactorial and include the lack of diagnostic criteria (although classification criteria exist) for axSpA and the difficulty in distinguishing inflammatory back pain, a key symptom of axSpA, from other highly prevalent forms of low back pain. We sought to describe reasons for diagnostic delay for axSpA provided by primary care physicians. Methods: We conducted a qualitative research study which included 18 US primary care physicians, balanced by gender. Physicians provided informed consent to participate in an in-depth interview (< 60 min), conducted in person (n = 3) or over the phone (n = 15), in 2019. The analysis focuses on thoughts about factors contributing to diagnostic delay in axSpA. Results: Physicians noted that the disease characteristics contributing to diagnostic delay include: back pain is common and axSpA is less prevalent, slow progression of axSpA, intermittent nature of axSpA pain, and in the absence of abnormal radiographs of the spine or sacroiliac joints, there is no definitive test for axSpA. Patient characteristics believed to contribute to diagnostic delay included having multiple conditions in need of attention, infrequent interactions with the health care system, and “doctor shopping.” Doctors noted that patients wait until the last moments of the clinical encounter to discuss back pain. Problematic physician characteristics included lack of rapport with patients, lack of setting appropriate expectations, and attribution of back pain to other factors. Structural/system issues included short appointments, lack of continuity of care, insufficient insurance coverage for tests, lack of back pain clinics, and a shortage of rheumatologists. Conclusion: Primary care physicians agreed that lengthy axSpA diagnosis delays are challenging to address owing to the multifactorial causes (e.g., disease characteristics, patient characteristics, lack of definitive tests, system factors). Keywords: Back pain, Diagnosis, Primary care, Qualitative research
* Correspondence: [email protected] 1 Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA 2 Sherman Center, University of Massachusetts Medical School, 55 Lake Avenue North, 6th floor, Worcester, MA 01655, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or
Data Loading...
