Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America.
Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America.
PLoS One. 2021 May 24;16(5):e0252018. doi: 10.1371/journal.pone.0252018. eCollection 2021.
Many patients with axial spondylarthritis (axSpA) experience lengthy diagnostic delays upwards of 14 years. (5-14 years). Screening tools for axSpA have been proposed for use in primary care settings, but whether this approach could be implemented into busy primary care settings remains unknown.
To solicit feedback from primary care physicians regarding questions from the Inflammatory Back Pain Assessment: the Assessment of Spondyloarthritis International Society (ASAS) Expert Criteria and gain insight about barriers and facilitators for implementing axSpA screening in primary care.
Guided by Consolidated Criteria for reporting Qualitative Research (COREQ-criteria), we recorded, transcribed, and analyzed in-depth interviews with eight family medicine physicians and ten internists (purposeful sampling) using immersion/crystallization techniques.
Few physicians reported awareness of existing classification criteria for axSpA, and many reported a lack of confidence in their ability to distinguish between inflammatory and mechanical back pain. From three domains, 10 subthemes emerged: 1) typical work-up of axSpA patients in primary care, with subthemes including the clues involved in work-up and role of clinical examinations for axSpA; 2) feedback on questions from the Inflammatory Back Pain Assessment: ASAS Expert Criteria, with subthemes to evaluate contents/questions of a potential screening tool for axSpA; and 3) implementation of the screening tool in primary care settings, with subthemes of perceived barriers including awareness, time, other conditions to screen, rare disease, and lack of structured questionnaire for back pain and perceived facilitators including workflow issues and awareness.
Primary care physicians believed that an improved screening instrument and a strong evidence-base to support the need for screening for axSpA are required. The implementation of axSpA screening into a busy primary care practice requires integration into the practice workflow, with use of technology suggested as a possible way to improve efficiency.
许多患有中轴型脊柱关节炎（axSpA）的患者经历了长达 14 年以上的漫长诊断延迟。（5-14 年）。已经提出了用于初级保健环境的 axSpA 筛查工具，但这种方法是否可以在繁忙的初级保健环境中实施尚不清楚。
征求初级保健医生对炎症性背痛评估的问题的反馈：评估强直性脊柱炎国际协会（ASAS）专家标准，并深入了解在初级保健中实施 axSpA 筛查的障碍和促进因素。
在综合定性研究报告标准（COREQ 标准）的指导下，我们使用浸入/结晶技术记录、转录和分析了 8 名家庭医生和 10 名内科医生的深入访谈（有目的的抽样）。
很少有医生报告说他们意识到现有的 axSpA 分类标准，而且许多医生报告说他们缺乏区分炎症性和机械性背痛的能力。从三个领域中出现了 10 个子主题：1）axSpA 患者在初级保健中的典型检查，包括检查中的线索和 axSpA 临床检查的作用；2）对炎症性背痛评估的问题的反馈：ASAS 专家标准，包括评估 axSpA 潜在筛查工具的内容/问题的子主题；3）在初级保健环境中实施筛查工具，包括意识、时间、要筛查的其他疾病、罕见疾病和缺乏背痛结构化问卷等感知障碍，以及工作流程问题和意识等感知促进因素。
初级保健医生认为需要改进筛查工具，并提供支持 axSpA 筛查必要性的强有力证据基础。将 axSpA 筛查纳入繁忙的初级保健实践需要将其整合到实践工作流程中，使用技术被认为是提高效率的一种可能方法。
