Assessment of quality of rheumatology care in a rural area of West Bengal, India

Abstract

Introduction: Patients with rheumatic symptoms are frequently misdiagnosed and mismanaged in rural areas. The present study was conducted to assess the level of accuracy in management of musculoskeletal (MSK) symptoms in rural patients. Materials and Methods: The study was conducted over 1-year period involving the patients with rheumatologic symptoms such as MSK pain, swelling and stiffness of joints, and managed outside previously before attending to us for these symptoms. Patients were interviewed regarding their past investigations, diagnosis offered, and management schedules. Level of misdiagnosis and mistreatment was evaluated. Results: One hundred and twenty-five patients (50%) were treated by quacks. Large number of patients also went to homeopathic (12%) and ayurvedic (4%) practitioners. Medical graduates treated 24% cases. Few patients went to postgraduate physicians (4%) or rheumatologists (0.8%). Misdiagnosis and mistreatment were common mainly with quacks and alternative medicine practitioners. Overall only 28.8% cases were diagnosed correctly. Investigations were suggested inappropriately such as antistreptolysin O titer, rheumatoid factor, and uric acid when these were not required. Medicines such as benzathine penicillin, steroid, etc., were prescribed inappropriately. Physiotherapy and rehabilitation were neglected. Conclusion: Gap in quality of rheumatology care is prevalent at rural areas. Awareness program and basic rheumatology training to rural health professionals are of high priority.

Keywords

• Antistreptolysin O titer
• benzathine penicillin
• low back pain
• soft tissue rheumatism
• steroid