Assessment of the Sources of Information by Patients With Rheumatic Diseases.

OBJECTIVE: The aim of this study was to ascertain the frequency of use, search intent (SI), level of accessibility, and degree of reliability of sources of information (SOIs) in rheumatology. METHODS: A survey among adult outpatients with rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and spondyloarthritis was conducted. They were asked if they had procured information from 12 selected SOIs during the past year. Search intent was defined as the source they would like to consult. Accessibility and reliability were assessed through 0-to-10 scales (minimum and maximum, respectively). RESULTS: Four hundred two patients were surveyed. They had consulted a median of 3 SOIs (interquartile range, 2-6) but described a higher SI: median of 5 SOIs (interquartile range 3-8); p = 0.001.The most consulted SOIs were the physician (83%), other patients (45%), and Facebook (36%). The main differences between SI and the searches actually performed were observed in community lectures by health care professionals (49%), scientific societies (48%), and associations of patients (27%); p < 0.001. These 3 sources showed low level of accessibility. Facebook, press, radio, and YouTube were the least reliable sources. CONCLUSIONS: Patients consulted a median of 3 SOIs but reported a significantly higher SI. Although patients demand more information, the request is leveled at SOIs with difficult accessibility but high reliability.

Description of the resources for rheumatology training and speciality certification and recertification requirements in Argentina.

The objective of the study was to analyse resources for rheumatology training, and speciality certification and recertification requirements in Argentina. Information was gathered regarding vacancies, entry requirements, duration and validity of the specialist degree in every residency and postgraduate course in adult rheumatology. The following aspects were analysed: monitoring authority, certification and recertification requirements, and mandatory recertification. Six out of 36 universities offer rheumatology postgraduate courses. Out of 65 vacancies, 36 (55%) are implemented by a National Public University in the Autonomous City of Buenos Aires (CABA), and 46 (70%) are in CABA. There are 32 vacancies for rheumatology residencies in 7 out of 24 districts, 16 of them (50%) in CABA. There are 2- to 3-year postgraduate courses; entry requirements range from 1-year experience in internal medicine to either complete residency or specialist degree in internal medicine. Training formats vary from full-time university residency to either university-based courses with part-time dedication in a rheumatology service without residency or non-university courses with part-time dedication. Not every specialist degree is automatically homologated in every jurisdiction. Provincial governments and colleges of physicians are the certification and recertification authorities; medical school was included in one district. Recertification is mandatory in only 8 districts; 40-50% of the process is achieved by merely practising as a rheumatologist. Most of the training resources are concentrated in CABA. Although there are various options, not all of them are automatically homologated. Recertification is not mandatory nationwide, and a significant part of the process involves practising as a rheumatologist.

Disability due to rheumatic diseases in the city of Junín, Argentina.

The aim of the study is to analyze the characteristics of patients with rheumatic diseases applying for a Disability Certificate (DC). Every application for DC filed by patients of 16 years of age and older in the Health Secretariat of Junin, between 2012 and 2016, was analyzed regarding age, gender, rheumatic disease as the cause of disability, employment status, and health insurance coverage. Applications were examined as per two elements: inflammatory articular or systemic disease (IASD) versus degenerative diseases, regional or generalized pain syndromes (non-IASD). Based on the DCs accepted, a Disability Prevalence Rate (DPR) was estimated and the most common causes of disability were determined. Out of 400 applications, 68% belonged to women; applicants' median age was 61 years, only 27% were working, 42% were for DC renewal, and 46% were IASD. Overall, 83% of the applications submitted were accepted. Those patients with accepted DC applications were older (median age 62 vs 55; p < 0.001), had health insurance coverage (90% vs 65%; p <0.001), were applying for DC renewal (49% vs 12%; p < 0.001) and more frequently presented a IASD (52% vs 17%; p < 0.001). 48% of accepted DC applications had osteoarthritis (OA), 36% rheumatoid arthritis (RA), 6% psoriatic arthritis (PsA), 5% systemic lupus erythematosus (SLE) and 2% ankylosing spondylitis (AS). The DPR was 0.5%. Overall, the accepted applications for DC belong to older patients with health insurance coverage, who were submitting an application for DC renewal and suffer from a IASD. OA, RA, PsA, SLE and AS were the five most common causes of disability.

Rheumatology Resources in a Region of Buenos Aires Province, Argentina.

BACKGROUND: Accurate knowledge of the available rheumatology workforce and their working conditions results in better care for patients with rheumatic diseases. OBJECTIVE: The aim of this study was to assess the rheumatology resources and their distribution within district V of the College of Physicians (COLMED5) of Buenos Aires Province, Argentina. METHODS: All the registered rheumatologists and all the registered public and private institutions within COLMED5 were identified. Aside from these data, phone calls, letters, Internet-derived information, and databases from public and private health insurance providers and the Argentine Society of Rheumatology were included as well. Rheumatologists' per-capita rates were built for both the whole district and every town. A rate of at least 1 rheumatologist per 50,000 people was deemed an optimal resource. RESULTS: Thirty-six rheumatologists were identified; the calculated rate was 1 rheumatologist per 68,403 people; 44% of the health care institutions had a rheumatologist; 33% of them were public institutions. Only 25.5% of COLMED5 total population had optimal rheumatology resources in their town, 70.3% did not reach the optimal resource level but at least had a rheumatologist in their town, and 4.2% had no resources whatsoever; 49% of the total population lacked public health care facilities with inpatient settings and rheumatologists in their town. CONCLUSIONS: Although COLMED5 has 72% of the optimal number of rheumatologists, because of their uneven distribution, only 25.5% of the district's total population has the optimal rheumatology resources in their town. Nearly half COLMED5 total population lacks public health care facilities with inpatient settings and rheumatologists in their town, and 4.2% has no available rheumatology resource at all.

Una encuesta sobre la evaluación y el tratamiento actual de la gota en Buenos Aires, Argentina / A survey on the current evaluation and treatment of gout in Buenos Aires, Argentina

Objetivo. Evaluar la gestión actual de la gota en los médicos generales y especialistas en Buenos Aires. Material y métodos. Preguntas de selección múltiple, encuesta anónima, realizada a 33 reumatólogos (REU), 52 especialistas en medicina interna (EMI) y 86 médicos generales (Otros). Resultados. Los REU atienden a pacientes con gota muy frecuentemente o habitualmente en un 51,5% de los casos vs. un 11,5% de EMI y un 8,1% de Otros. Al momento del diagnóstico, los cristales de ácido úrico fueron identificados por un 51,5% de REU vs. un 28,8% de EMI y Otros 26,7%; los tofos fueron identificados por un 60,6% de REU % vs. un 30,8% de EMI y un 30,2% Otros. Los REU y los EMI usan colchicina para la gota aguda en el 75,8 y el 80,8%, respectivamente, frente al 7,7% de Otros. La medida de altura/peso y la circunferencia de la cintura del paciente fue realizada con menos frecuencia por REU que por EMI (el 66,7 vs. el 92,3% y el 45,5 vs. el 75%, respectivamente). Conclusiones. Los REU suelen examinar a los pacientes con gota, pero en una etapa crónica. La identificación de los cristales en el líquido sinovial es baja. El uso de colchicina sigue siendo alto. Los REU deben mejorar la evaluación del síndrome metabólico (AU)

Objective: To evaluate the current management of gout in general practitioners and specialists in Buenos Aires city. Material and methods: multiple choice, anonimous, survey, performed to 33 rheumatologists (REU), 52 Internal Medicine specialists (EMI) and 86 general practitioners (Otros). Results: Gout is a very common or usual disease for 51.5% of REU vs 11.5% EMI and 8.1% Otros. At diagnosis, uric acid crystals are identified by 51.5% REU vs 28.8% EMI and 26.7% Otros and tophi observed by 60.6% REU vs 30.8% EMI and 30.2% Otros. REU and EMI should indicate colchicine for acute gout in 75.8% and 80.8% respectively vs 7.7% of Otros. REU measure patient’s height/weight and waist circumference less frequently than EMI (66.7% vs 92.3% and 45.5% vs 75% respectively). Conclusions: REU usually examine patients with gout but in a chronic stage. The identification of crystals in synovial fluid is low. The use ofcolchicine is still high. REU should improve the evaluation of the metabolic syndrome (AU)

A survey on the current evaluation and treatment of gout in Buenos Aires, Argentina.

OBJECTIVE: To evaluate the current management of gout in general practitioners and specialists in Buenos Aires city. MATERIAL AND METHODS: multiple choice, anonimous, survey, performed to 33 rheumatologists (REU), 52 Internal Medicine specialists (EMI) and 86 general practitioners (Otros). RESULTS: Gout is a very common or usual disease for 51.5% of REU vs 11.5% EMI and 8.1% Otros. At diagnosis, uric acid crystals are identified by 51.5% REU vs 28.8% EMI and 26.7% Otros and tophi observed by 60.6% REU vs 30.8% EMI and 30.2% Otros. REU and EMI should indicate colchicine for acute gout in 75.8% and 80.8% respectively vs 7.7% of Otros. REU measure patient's height/weight and waist circumference less frequently than EMI (66.7% vs 92.3% and 45.5% vs 75% respectively). CONCLUSIONS: REU usually examine patients with gout but in a chronic stage. The identification of crystals in synovial fluid is low. The use ofcolchicine is still high. REU should improve the evaluation of the metabolic syndrome.