title: Identifying barriers to the care of the rheumatoid hand in China: comparing attitudes of rheumatologists and hand surgeons.
abstract: OBJECTIVE
  In China, hand surgeons treat fewer rheumatoid arthritis (RA) patients compared to other countries. We investigated whether physician and surgeon knowledge, attitudes and practices regarding RA hand deformities reflect current evidence and may contribute to the low utilization of surgery.
  
  
  METHODS
  We surveyed hand surgeons and rheumatologists at three tertiary hospitals in Beijing, China. Questionnaires were developed from literature and expert review to assess their knowledge, attitudes and practice patterns related to rheumatoid hand surgery.
  
  
  RESULTS
  Thirty-five hand surgeons and 59 rheumatologists completed the survey. Roughly one-third felt that the rheumatologists and hand surgeons agree on how to manage RA hand deformities. One-fifth of rheumatologists and 29% of hand surgeons believed that drug therapy can correct hand deformities, which contradicts current evidence. Likewise, 30% and 14%, respectively, recommended surgery for early-stage hand sequelae that do not meet current indications for surgery. Over 80% of surgeons and rheumatologists had no exposure to the other specialty during training and felt their training on the treatment of rheumatoid hand deformities was inadequate.
  
  
  CONCLUSIONS
  Although we found similar interspeciality disagreement in China as is seen in the United States, there appears to be less interaction through training and consultations. Our results also indicate potential deficits in training and unawareness of evidence and indications for rheumatoid hand surgery. These findings help to explain why surgery for rheumatoid hand deformities is rare in China; doctors have fewer opportunities to collaborate across specialties and may not be able to select appropriate candidates for surgery.
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Franzblau
authors.affiliation: 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Keming
authors.initials: K
authors.lastname: Wang
authors.affiliation: 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Xuebing
authors.initials: X
authors.lastname: Liang
authors.affiliation: Department of Hand Surgery, Jishuitan Hospital, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China.
authors.forename: Yingni
authors.initials: Y
authors.lastname: Li
authors.affiliation: Survey Research Center, Ann Arbor, MI, USA.
authors.forename: Yu-Chieh Jay
authors.initials: YJ
authors.lastname: Lin
authors.affiliation: Survey Methodology Program, Institute for Social Research, Ann Arbor, MI, USA.
authors.forename: Sunghee
authors.initials: S
authors.lastname: Lee
authors.affiliation: Survey Research Center, Ann Arbor, MI, USA.
authors.forename: Beth-Ellen
authors.initials: BE
authors.lastname: Pennell
authors.affiliation: Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Shauver
authors.affiliation: Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001291:Attitude of Health Personnel; D000068476:Beijing; D005260:Female; D006227:Hand Deformities, Acquired / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D050823:Hand Joints / Q000503:physiopathology / Q000601:surgery*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D000072161:Orthopedic Surgeons / Q000523:psychology*; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D000072140:Rheumatologists / Q000523:psychology*
keywords: China; hand surgery; rheumatoid arthritis; rheumatology; survey