MANAGEMENT OF THE EARLY AND LATE PRESENTATIONS OF RHEUMATOID-ARTHRITIS - A SURVEY OF ONTARIO PRIMARY-CARE PHYSICIANS

Objective: To examine primary care physicians' management of rheumatoi d arthritis, ascertain the determinants of management and compare mana gement with that recommended by a current practice panel. Design: Mail survey (self-administered questionnaire). Setting: Ontario. Participa nts: A stratified computer-generated random sample of 798 members of t he College of Family Physicians of Canada. Outcome measures: Proportio ns of respondents who chose various items in the management of two hyp othetical patients, one with early rheumatoid arthritis and one with l ate rheumatoid arthritis. Scores for investigations, interventions and referrals for each scenario were generated by summing the recommended items chosen by respondents and then dividing by the total number of items recommended in that category. The scores were examined for their association with physician and practice characteristics and physician attitudes. Results: The response rare was 48.3% (529/275 eligible phy sicians). Recommended investigations were chosen by more than two thir ds of the respondents for both scenarios. Referrals to physiotherapy, oc cupational therapy and rheumatology, all recommended by the panel, were chosen by 206 (38.9%), 72 (13.6%) and 309 (58.4%) physicians resp ectively for early rheumatoid arthritis. These proportions were signif icantly higher for late rheumatoid arthritis (p < 0.01). In multiple r egression analysis, for early rheumatoid arthritis, internship or resi dency training in rheumatology was associated with higher investigatio n and intervention scores, for late rheumatoid arthritis, older physic ians had higher intervention scores and female physicians had higher r eferral scores. Conclusions: Primary care physicians' investigation of rheumatoid arthritis was in accord with panel recommendations. Howeve r, rates of referral to rheumatologists and other health care professi onals were very low, especially for the early presentation of rheumato id arthritis; More exposure to rheumatology and to the role of physiot herapy, occupational therapy and social work during primary care train ing is strongly recommended.