AB1261 Development of a local needs-based gp curriculum for shared care in rheumatology
Authors: O. Hussein, T. Duffy
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> There is a role for shared care between rheumatologist and primary care for Musculoskeletal (MSK) disorders. General practitioners (GPs) are involved in monitoring of clinical status of patients and their management, in addition to psychosocial aspects of chronic pain and disability. We are going to look at the rheumatology knowledge and skills needed by local GPs and based on their needs we plan to develop an initiative to improve the service provided to our patients. Here are the results of the initial survey of local GPs. <h3>Objectives</h3> We aim to identify knowledge and skill gaps in primary care related to MSK disorders and to develop a need-based curriculum to address these gaps. Develop an implementation plan to deliver the curriculum components. <h3>Methods</h3> Initially we identify the needs and gaps in the current practice using survey in a small group of local GPs. There are two rounds of questionnaires to reach a list of important areas to develop the curriculum. The second round will include large number of GPs. Also, there will be meetings with GPs to reach agreement and to adopt method of delivering these training and skills. <h3>Results</h3> In the first survey, 31 out of 36 GPs (86%) returned questionnaires. One GP (3.2%) refer to rheumatology department twice a week, 4 GPs (13%) refer weekly, 23 GPs (74%) refer every month and three GPs (9.7%) rarely refer to rheumatologist. Reasons for referral were diagnosis and long-term management,<sup>21</sup> diagnosis and discharge back to GP<sup>15</sup> and patient's request.<sup>4</sup> Thirteen GPs (42%) have interest in rheumatology conditions management. Regarding GPs' concerns with rheumatology service, 22 of them (71%) mentioned the long wait time for rheumatology appointment. Other issues were delayed clinic letter, need for clear instruction, patients not aware of appointment time, whether there is an urgent clinic and which clinic patient should be referred to (outpatient versus procedure clinics). Nineteen GPs (61%) received undergraduate rheumatology training, 16 (52%) during GP training programme and 4 (13%) attended postgraduate courses. Topics of interest by GPs were variable rheumatology conditions in addition to joint injections,<sup>3</sup> referral guidance<sup>2</sup> and update on DMARD. Preferred teaching methods to deliver the syllabus were small group tutorials,<sup>12</sup> face-to-face lectures<sup>8</sup> and protocols and guidelines.<sup>5</sup> <h3>Conclusions</h3> From this initial survey, we could identify that the major concern of local GPs is the long waiting time for rheumatology clinic. Some of GPs (42%) expressed their interest to have further training in rheumatology. When we reach an agreed curriculum with GPs, we aim to deliver the syllabus through preferred methods by GPs. Shared care between rheumatologists and GPs would improve quality standard of care in community, provide patient care close to home and reduce referral rates. <h3>References</h3> [1] Teaching rheumatology in primary care, Ann Rheum Dis. 2000, G. Hosie. [2] Musculoskeletal education in US medical schools:lessons from the past and suggestions for the future, Curr Rev Musculoskelet Med.2011, Seetha U. Monrad. [3] Development of a competency framework for general practitioners with a special interest in musculoskeletal/rheumatology practice, Rheumatology 2007, E. M. Hay. [4] Assessing the Need for Improved Access to Rheumatology Care: A Survey of Massachusetts Community Health Center Medical Directors, J Clin Rheumatol, 2013. <h3>Disclosure of Interest</h3> None declared