title: Education improves referral of patients suspected of having spondyloarthritis by general practitioners: a study with unannounced standardised patients in daily practice.
abstract: OBJECTIVE
  To evaluate the practice performance of general practitioners (GPs) and GP residents in recognising and referring patients suspected for having axial or peripheral spondyloarthritis (SpA), and to investigate the influence of education on this performance.
  
  
  METHODS
  GP (residents) were visited in two rounds by standardised patients (SPs) simulating axial SpA, peripheral SpA or carpal tunnel syndrome (CTS) with in between an educational intervention on SpA for part of the participants. Participants were unaware of the nature of the medical problem and study purpose. CTS was included as diversionary tactic. The primary outcome was ≥40% improvement in (considering) referral of the SPs with SpA to the rheumatologist after education. Secondary outcomes included ordering additional diagnostic tests, correct recognition of SpA and identification of variables contributing to this.
  
  
  RESULTS
  68 participants (30 GPs and 38 GP residents) were included, of which 19 received education. The primary outcome was met. A significantly higher proportion of GP (residents) from the intervention group referred patients to the rheumatologist compared with the control group after education (change scores, axial SpA +71% vs +15% (p<0.01); peripheral SpA +48% vs 0% (p<0.001)). Participants who received education, more frequently correctly recognised SpA compared with controls (change scores, axial SpA +50% vs -5% (p<0.001); peripheral SpA +21% vs 0% (p=0.01).
  
  
  CONCLUSIONS
  Recognition and referral of patients suspected for having SpA by GP (residents) is low, but targeted education markedly improved this. This supports the development of educational initiatives to improve recognition of SpA and hence referral to a rheumatologist.
authors.affiliation: Department of Medicine, Division of Rheumatology , Maastricht University Medical Centre, Maastricht and School for Public Health and Primary Care (CAPHRI), Maastricht University , Maastricht, Limburg , The Netherlands.
authors.forename: Marloes
authors.initials: M
authors.lastname: van Onna
authors.affiliation: Department of Medicine, Division of Rheumatology , Maastricht University Medical Centre, Maastricht and School for Public Health and Primary Care (CAPHRI), Maastricht University , Maastricht, Limburg , The Netherlands.
authors.forename: Simone
authors.initials: S
authors.lastname: Gorter
authors.affiliation: Department of General Practice , Maastricht University , Maastricht , The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: Maiburg
authors.affiliation: Department of General Practice , Maastricht University , Maastricht , The Netherlands.
authors.forename: Gerrie
authors.initials: G
authors.lastname: Waagenaar
authors.affiliation: Department of Medicine, Division of Rheumatology , Maastricht University Medical Centre, Maastricht and School for Public Health and Primary Care (CAPHRI), Maastricht University , Maastricht, Limburg , The Netherlands.
authors.forename: Astrid
authors.initials: A
authors.lastname: van Tubergen
keywords: Low Back Pain; Outcomes research; Spondyloarthritis