title: Are spondyloarthropathies adequately referred from primary care to specialized care?
abstract: OBJECTIVE
  To evaluate the degree of agreement between primary care physicians and rheumatologists when evaluating the referral criteria in patients with suspected early spondyloarthropathy (Spa).
  
  
  METHODS
  Patients with suspected early Spa (according to predefined clinical referral criteria) were sent by primary care physicians to early Spa units (where a rheumatologist evaluated the same criteria and confirmed the diagnosis) through an on-line platform. We assessed the agreement between primary care physicians and rheumatologists regarding the predefined clinical referral criteria among patients with definitive Spa using the kappa index (k).
  
  
  RESULTS
  Eight hundred and two patients were analysed, 8.31% of whom were incorrectly referred to the rheumatologist. The degree of agreement regarding the predefined clinical referral criteria was poor for inflammatory back pain (k=0,16; 95% confidence interval [95% CI] 0,09-0,23), radiographic sacroiliitis (k=0,31; 95% CI 0,211-0,428), back or joint pain (k=0,21; 95% CI 0,14-0,29); mild for asymmetric arthritis (k=0,51; 95% CI 0,43-0,59), positive HLA B27 (k=0,59; 95% CI 0,52-0,67) and family history (k=0,50; 95% CI 0,415-0,604); and it was good or very good for anterior uveitis (k=0,81; 95% CI 0,68-0,93), inflammatory bowel disease (k=0,87; 95% CI 0,79-0,96) and psoriasis (k=0,73; 95% CI 0,65-0,81),.
  
  
  CONCLUSIONS
  The degree of agreement between primary care physicians and rheumatologists regarding the predefined clinical referral criteria was variable. Agreement was very poor for variables like inflammatory back pain, which are crucial for the diagnosis of Spa. Training programs for primary care physicians are important in order for them to correctly identify early Spa patients.
authors.affiliation: Servicio de Reumatología, Hospital Universitario de Salamanca, Salamanca, España. lopezgonzalezruth@gmail.com
authors.forename: Ruth
authors.initials: R
authors.lastname: López-González
authors.forename: Azucena
authors.initials: A
authors.lastname: Hernández-Sanz
authors.forename: Raquel
authors.initials: R
authors.lastname: Almodóvar-González
authors.forename: Milena
authors.initials: M
authors.lastname: Gobbo
mesh_terms: D000293:Adolescent; D000328:Adult; D042241:Early Diagnosis; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D012017:Referral and Consultation / Q000458:organization & administration / Q000592:standards*; D012219:Rheumatology / Q000592:standards*; D013030:Spain; D025242:Spondylarthropathies / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult