By Dr Irwin Lim, Rheumatologist
I had previously written about our clinic's attempt to engage our surrounding GPs on the topic of inflammatory arthritis. I must admit being a bit disheartened but not surprised after the 1st mailout (click here to see the letter) failed to lead to any obvious change.
Our leadership group decided that we needed multiple "touches", multiple messages/reminders, and at the risk of alienating some of our GP referrers as we added to their already large pile of mail, we embarked on a program of 1 letter every month or two, regarding this topic.
Here's the body of the 4th letter:
"Re: What do we mean by INFLAMMATORY ARTHRITIS
We’ve been writing to you about Inflammatory Arthritis, so we thought we’d try to help you pick these patients.
Alarm signals to consider:
- Soft tissue swelling at the joints
- Early Morning Stiffness lasting longer than a few minutes
- Night symptoms
- Pain on squeezing joints for eg squeezing the forefoot
- Swelling that improves with NSAIDs
Please don’t rely on tests alone! A large proportion are unhelpful:
- Xrays are negative in the vast majority
- CRP/ESR may be normal in up to 50%
- RF and anti-CCP may be negative in up to 40%
Please contact us by phone, fax or email so that we can make sure that your patients get an appointment quickly. Our rheumatologists collaborate and we will ensure that these patients are seen within a week."
These letters were sent to about 1500 GPs in the suburbs surrounding our clinics. We hope that most envelopes are opened and that some of the letters are read.
It seems the message may be getting through. After 5 months and 4 letters around the topic, we've noted a number of patients being referred earlier with inflammatory arthritis. In a few cases, the GPs did ring up on behalf of the patient for an early appointment.
This is a heartening result. I do hope it continues.
What do you think of this tactic?Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here. Arthritis requires an integrated approach. We call this, Connected Care. Contact us.