Table 7 Codebook for primary care physician interviews

Patient characteristics

Any mention of these sociodemographic factors, as they relate to diagnosing, “textbook cases”, thoughts about axSpA, etc.

a. Age

b. Weight-status/obesity

c. Sex/gender

d. Socioeconomic status

e. Employment

f. Multiple comorbidities

Approaches to diagnosing axSpA

All quotes falling under this code should refer to axSpA specifically, not general back pain, acute injuries, etc.

a. Typical presentation of axSpA

b. Clues within workup pointing towards axSpA

c. Triggering events

d. Medical history

e. Imaging and lab tests if axSpA is suspected

f. Ruling out other diagnoses

Reasons for diagnostic delay

a. Back pain is common and causes are multifactorial

b. axSpA is rare and has vague/nebulous symptoms

c. Challenges faced by PCPs regarding rare/specialized conditions

d. Structural barriers within healthcare system

e. Wary of drug seeking behavior

Overcoming delays

Factors that could reduce the diagnostic delay (note: can include the need to implement a screening process)

Referrals

a. Access

b. Physical therapy

c. Rheumatology

d. Other specialists

Screening

a. Barriers = what makes screening difficult

b. Facilitators = what would make screening easier or likely to be implemented

c. General thoughts = current approaches, brainstorming other strategies currently being used or that could be used (e.g., NLP)

axSpA Awareness

Brief response to question about whether they and/or colleagues are aware of axSpA and whether they believe the diagnostic delay is an issue

Screening questions

a. Question 1: Have you suffered from back pain for more than 3 months?

b. Question 2: Did your back pain start when you were aged 40 or under?

c. Question 3: Did your back pain develop gradually?

d. Question 4: Does your back pain improve with exercise?

e. Question 5: Do you find there is no improvement in your back pain when you rest?

f. Question 6: Do you suffer from back pain at night which improves upon getting up?

g. Recommendations