E091 Improving recognition and referrals for axial spondyloarthritis in primary care

Abstract

Abstract Background/Aims It is estimated there is an 8.5-year delay from onset of symptoms to diagnosis of axial spondyloarthritis. The condition is poorly recognised in the United Kingdom. An audit of a general practice with 7,500 patients revealed only 7 patients living with the diagnosis, of which only 2 were diagnosed before the age of 45. Estimates suggest this figure should be closer to 35 to 40. In the 12 months prior to the audit, only 2 referrals were sent to rheumatology suspecting axial spondyloarthritis. The short-term aim of this study was to improve the recognition and referrals for axial spondyloarthritis in primary care from 2 per year to 15. The long-term goal is to increase the number of patients living with the diagnosis from 7 to 37. Methods EMIS alerts and pop-ups were created for patients, aged 20-45, presenting with “low back pain” or a similar coding to increase clinicians' clinical suspicion index. The alerts and pops included a hyperlink to the SPADE tool to facilitate reasoning. This was consolidated with an education webinar to refresh General Practitioners and Advanced Nurse Practitioners on the diagnostic criteria for axial spondyloarthritis. Results Following implementation of alerts and hyperlinks to the SPADE tool, general practitioners' confidence and knowledge of knowing when to suspect, assess and refer axial spondyloarthritis increased from 1.9, 1.7 and 2 to 4.8, 4.4 and 4.2 on a 5 point self-rated Likert scale. In the 12 months following the intervention, number of referrals had increased from 2 per year to 11. Conclusion This study has highlighted various findings. It has highlighted an insufficient number of referrals to rheumatology suspecting axial spondyloarthritis in order to maintain the suspected population of a general practice. This is likely linked to poor awareness and screening of the condition. It has also highlighted that clinicians in primary care respond positively to training for knowing when to suspect, assess and refer on for axial spondyloarthritis. However, this only measured a short-term change in knowledge and further testing is required to assess long term change. Furthermore, combined with education and the use of pop up and alerts has increased the awareness and referrals for axial spondyloarthritis from primary to secondary care. Future audits are required in the long term to assess for success in the long term goal. Disclosure D. Hamilton: None.