title: A general practice perspective on early rheumatoid arthritis management: A qualitative study from Flanders.
abstract: BACKGROUND
  General practitioners (GPs) may play a crucial role in early recognition, rapid referral and intensive treatment follow-up of patients with rheumatoid arthritis (RA). To improve early RA management, perceived barriers in general practice must be addressed. However, the general practice perspective on early RA management remains understudied.
  
  
  OBJECTIVE
  To explore GPs' experiences, beliefs and attitudes regarding detection, referral, and intensive treatment for early RA.
  
  
  METHODS
  In 2014, a qualitative study was conducted by means of individual, in depth, face-to-face interviews of a purposive sample of 13 Flemish GPs. Interviews were audio-recorded, transcribed verbatim and coded using the constant comparative method.
  
  
  RESULTS
  GPs applied multiple assessment techniques for early RA detection and regularly prescribed non-steroidal anti-inflammatory drugs if they suspected early RA. However, GPs felt unconfident about their detection skills because early RA symptoms are often unclear, diagnostic tests could provide inconclusive results and the incidence is low in general practice. GPs mentioned various approaches and multiple factors determining their referral decision. Perceived referral barriers included limited availability of rheumatology services and long waiting times. GPs considered intensive treatment initiation to be the expertise of rheumatologists. Reported key barriers to intensive treatment included patients' resistance and non-adherence, lack of GP involvement and unsatisfactory collaboration with rheumatology services.
  
  
  CONCLUSIONS
  GPs acknowledge the importance of an early and intensive treatment, but experience various barriers in the management of early RA. GPs should enhance their skills to detect early RA and should actively be involved in early RA care.
authors.affiliation: a Department of Development and Regeneration , Skeletal Biology and Engineering Research Centre, KU Leuven , Leuven , Belgium .
authors.forename: Sabrina
authors.initials: S
authors.lastname: Meyfroidt
authors.affiliation: b Department of Public Health and Primary Care , Institute for Healthcare Management & Policy, KU Leuven , Leuven , Belgium .
authors.forename: Judith
authors.initials: J
authors.lastname: Stevens
authors.affiliation: c Department of Public Health and Primary Care , Academic Centre for General Practice, KU Leuven , Leuven , Belgium .
authors.forename: Jan
authors.initials: J
authors.lastname: De Lepeleire
authors.affiliation: a Department of Development and Regeneration , Skeletal Biology and Engineering Research Centre, KU Leuven , Leuven , Belgium .|d Rheumatology , University Hospitals of Leuven , Leuven , Belgium , and.
authors.forename: Rene
authors.initials: R
authors.lastname: Westhovens
authors.affiliation: a Department of Development and Regeneration , Skeletal Biology and Engineering Research Centre, KU Leuven , Leuven , Belgium .
authors.forename: Diederik
authors.initials: D
authors.lastname: De Cock
authors.affiliation: a Department of Development and Regeneration , Skeletal Biology and Engineering Research Centre, KU Leuven , Leuven , Belgium .|d Rheumatology , University Hospitals of Leuven , Leuven , Belgium , and.
authors.forename: Kristien
authors.initials: K
authors.lastname: Van der Elst
authors.affiliation: b Department of Public Health and Primary Care , Institute for Healthcare Management & Policy, KU Leuven , Leuven , Belgium .|e Department of Quality Management , University Hospitals of Leuven , Leuven , Belgium.
authors.forename: Kris
authors.initials: K
authors.lastname: Vanhaecht
authors.affiliation: a Department of Development and Regeneration , Skeletal Biology and Engineering Research Centre, KU Leuven , Leuven , Belgium .|d Rheumatology , University Hospitals of Leuven , Leuven , Belgium , and.
authors.forename: Patrick
authors.initials: P
authors.lastname: Verschueren
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000628:therapy*; D001294:Attitude to Health; D001530:Belgium; D019468:Disease Management; D042241:Early Diagnosis; D061345:Early Medical Intervention; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D036301:Qualitative Research; D012017:Referral and Consultation; D012424:Rural Population; D014505:Urban Population
keywords: Arthritis; general practice; qualitative research; rheumatoid