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Table 5 System/structural characteristics contributing to diagnostic delay for patients with axSpA

From: Primary care physician perspectives on barriers to diagnosing axial Spondyloarthritis: a qualitative study

  Sample Quotes
Length of time for appointments needs to be longer D27: Time is a constraint. I would love to have 30 min for every problem a patient comes in and then I think this wouldn’t be an issue.
Lack of continuity of care D3: Well, I would actually wonder how many of those people were not getting regular care like with the same physician, like continuous care. So, you know a lot of say younger people who go to an urgent care center are like you know … “Oh, I’m here and I’ve got low back pain” and for the doctor it’s like, let me give them a shot of Toradol and send them on their way, “Here’s some anti-inflammatory meds, follow up with your primary care.”
D32: They [patients] get kind of used to the pain, and they’ve kind of seen doctors who have examined them and said, hey, everything looks fine. You don’t need to keep coming in.
Costs of tests expensive D24: I see so many people with back pain, a subset of those I test for autoimmune diseases, but even when I’m doing that, if I’m going to test or something like B27, I can’t really use it as a screening test because insurance doesn’t pay for those sort of tests just for a diagnosis of back pain … Uveitis, I think it will get covered, but, I mean, people get upset when they get a big bill; why did you do all these blood tests on me?
D12: Once I see, yes, it’s heading in that direction, I’ll probably do blood work and their clear blood work, ANA, HLA-B27, which I kind of wait, because it might be an expensive.
Lack of back pain clinics D11: Chronic back pain, no one wants to see them, no one wants to own them.
D29: Yeah, so our orthopedists don’t see back, so only our neurologist will see our back patients, if we have anybody. I don’t think rheum sees back.
D28: Oh, yeah; it’s the most difficult thing to -- the single worst referral is the referral for the rheumatologist.
Shortage of available rheumatologists D31: The issue is we don’t have many rheumatologists at all. There’s a shortage. … the nearest rheumatologist, I think, is probably going to be at least an hour drive away or maybe like 45–50 miles.
D24: We don’t have rheumatology in our county, so that’s an out of county referral and much harder to get an appointment.