P012 Raynaud's phenomenon: a primary care problem?

Abstract

Abstract Background/Aims Despite an established awareness of Raynaud’s phenomenon (RP), defined as an episodic vasospasm of the arteries in the extremities, no studies have yet described the way in which the phenomenon is assessed and managed within a primary care setting. The primary aim of this study is to evaluate the way in which Raynaud’s Phenomenon commonly presents, is investigated, and managed within a UK general practice (GP); auditing concordance with the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary (CKS) 2020 guidance. Methods An audit of 79 patients with a coded diagnosis of RP was completed at Green Lane Medical Centre, a Merseyside General Practice. Patient care was audited against standards within the NICE CKS. Results The patient group was comprised of 53 females (67.1%) and 26 males (32.9%). 89.9% (71/79) of patients have a working diagnosis of primary RP. Patient age at the time of audit: 4% aged 0-18; 29% aged 19-45; 30% aged 46-60; 37% aged 60+. 59.5% (47/79) of patients had 2 or more troubling symptoms of RP documented by their GP, with 12.7% (10/79) describing a classic triphasic colour change. Examination findings were documented for 55.7% (44/79) of patients and 27.9% (22/79) received an autoantibody screen. 26.6% (21/79) of patients were referred to secondary care, with 42.9% (9/21) of these referrals specifying an intention to rule out Secondary RP. Documentation available regarding patient management indicated that conservative advice was provided to 62.5% (40/64) of patients, the most common being a patient information sheet (26/64). Medical management was offered to 39.1% (25/64) of patients but was declined by 24.0% (6/25) of those to whom it was offered, with most (16/19) patients who were commenced on medical therapy discontinuing by the time of audit. In secondary care, 81.0% (17/21) of referred patients had further investigations, 57.1% (12/21) received reassurance before or after the investigations and conservative advice was the most common management. Conclusion This study suggests that GPs play a major role in the assessment and management of patients with RP; 73.4% (58/79) of patients were not referred to secondary care. Of those that were referred, the majority were due to worsening or severe symptoms, or suspected secondary RP, in line with the CKS guidance. Most patients present with 2 or more of the symptoms described in the NICE CKS guidance and the use of examination and screening blood tests in primary care appears to be the mainstay of assessment. In accordance with the CKS guidance, most patients are provided with information and lifestyle advice. High rates of medical therapy discontinuation suggest that assessment of severity of symptoms and improved patient education of medication side effects may play a role in determining the most appropriate candidates for medical therapy. Disclosure K.E. Winstone: None. M.E. Anderson: None. A.E. Stickland: None.