AB1239 The brazilian rheumatology triage: an assessment of the primary healthcare system
Authors: F.M. Borghi, B.B.R. Chu, D.N. Dias, S.C. Kowalski, P.R. Donadio
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> There are more than 100 rheumatic diseases involving 10% of the population. Their clinical manifestations and treatment vary but generally progress to disability. Recently, new technologies in rheumatology are available for diagnosis and treatment. However, the timely diagnosis and access to treatment are essential to prevent disability. Many barriers for the access to the rheumatologist have been identified, namely: population lack of knowledge regarding rheumatic diseases, lack of prioritisation in the reference process from primary care to rheumatologists, and scarcity of rheumatologists. Therefore, it is fundamental to address all the barriers and present facilitators in the healthcare system to ensure that rheumatic patients have timely access to rheumatologists. <h3>Objectives</h3> To assess the primary healthcare triage system in Maringa, a countryside city in the state of Parana-Brazil. Mainly, identifying barriers (waiting time from symptoms to primary care visit, to timely access to rheumatologists and beginning the treatment). <h3>Methods</h3> This is a cross-sectional study. The population of Maringa in 2016 was 399.605 people. There were 1200 patients in the waiting list for rheumatologists (2016). Medical records were analysed to describe the format and content of referrals, the duration of symptoms, exams ordered, and diagnosis agreement with rheumatologists. <h3>Results</h3> Medical records of 774 women and 147 men were analysed. The mean(SD) age was 55,1 (16)yrs. old. The median (IQR) time from symptoms to the rheumatologic visit was 16 mo. (9 to 28). About 10% of the referrals did not mention any detail about physical examination or diagnosis. 207 (22%) had diagnosis of gout, osteoporosis, rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus. 111 patients (10%) cancelled their visits. <h3>Conclusions</h3> The period from the symptoms to the visit with rheumatologists was large. The format and content of the referrals were incomplete. There were many patients that cancelled the visits with unknown prognosis. Educational initiatives should be implemented in Maringa-Brazil to enhance the skills of the primary care physicians to establish referral priorities and to start timely treatment. <h3>References</h3> [1] GAMEZ-NAVA, J. I. et al. Referral and diagnosis of common rheumatic diseases by primary care physicians. Br J Rheumatol, v. 37, n. 11, p. 1215–9, Nov 1998. ISSN 0263–7103. Disponível em: &amp;lt; https://www.ncbi.nlm.nih.gov/pubmed/9851272 [2] VILLENEUVE, E. et al. A systematic literature review of strategies promoting early referral and reducing delays in the diagnosis and management of inflammatory arthritis. Ann Rheum Dis, v. 72, n. 1, p. 13–22, Jan 2013. ISSN 1468–2060. Disponível em: &amp;lt; https://www.ncbi.nlm.nih.gov/pubmed/22532640 [3] WIDDIFIELD, J. et al. Wait times to rheumatology care for patients with rheumatic diseases: a data linkage study of primary care electronic medical records and administrative data. CMAJ Open, v. 4, n. 2, p. E205–12, 2016 Apr-Jun 2016. ISSN 2291–0026. <h3>Disclosure of Interest</h3> None declared