Xavier Juanola Roura1, Eduardo Collantes Estévez2, Fernando León Vázquez3, Antonio Torres Villamor4, María Jesús García Yébenes5, Rubén Queiro Silva6, Jordi Gratacós Masmitja7, Emilio García Criado8, Sergio Giménez9, Loreto Carmona10. 1. Servicio de Reumatología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, España; Institut d'Investigació Biomédica de Bellvitge, Barcelona, España; Grupo de Estudio de las Espondiloartritis de la SER. 2. Instituto Maimónides de Investigación Biomédica de Córdoba,, Córdoba, España; Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, España; Universidad de Córdoba, Córdoba, España; Grupo de Estudio de las Espondiloartritis de la SER. 3. Centro de Salud Universitario San Juan de la Cruz, Pozuelo de Alarcón, Madrid, España. 4. Centro de Salud Arroyo de la Media Legua, Servicio Madrileño de Salud, Madrid, España. 5. Instituto de Salud Musculoesquelética, Madrid, España. 6. Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Grupo de Estudio de las Espondiloartritis de la SER. 7. Hospital Parc Taulí, Sabadell, Barcelona, España; Grupo de Estudio de las Espondiloartritis de la SER. 8. Unidad de Gestión Clínica Fuensanta, Córdoba, España; Sociedad Española de Médicos de Atención Primaria (SEMERGEN-AP). 9. Unidad de Gestión Clínica Limonar, Málaga, España; Sociedad Española de Médicos de Atención Primaria (SEMERGEN-AP). 10. Instituto de Salud Musculoesquelética, Madrid, España. Electronic address: loreto.carmona@inmusc.eu.
Abstract
OBJECTIVE: To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians. METHODS: We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round. RESULTS: We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years be performed in four phases 1) clinical: key questions, 2) clinical: extra questions, 3) physical examination, and 4) additional tests. CONCLUSIONS: The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments.
OBJECTIVE: To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians. METHODS: We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round. RESULTS: We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years be performed in four phases 1) clinical: key questions, 2) clinical: extra questions, 3) physical examination, and 4) additional tests. CONCLUSIONS: The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments.
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