Primary care physicians (PCPs), which include general internists and family medicine doctors, typically manage and coordinate most of the health care a patient receives.1,2 They are usually the first point of contact for questions, new problems, and injuries. When a patient presents with a symptom that may indicate a rheumatological condition, PCPs are critical in helping in initial assessment and to guide further workup and evaluation, whether by the rheumatologist or another specialist. They also perform wellness check-ups and critical screening, such as for cancer and risk factors for heart attack and stroke.3 Screening can result in early identification of cancers allowing for more effective and optimized treatments. PCPs provide lifestyle counseling for preventable conditions such as hypertension, hyperlipidemia, and type 2 diabetes.2 They offer first line treatment for chronic conditions with the goal of preventing disease progression and morbidity.
Although rheumatologists, the specialists for patients with lupus, have special training to help manage their disease, before diagnosis patients are more likely to have access to a PCP. Therefore, PCPs may be the first physician to encounter symptoms of systemic lupus erythematosus. For this reason, a committee of the American College of Rheumatology recommended that the role of PCPs is understanding the manifestations of lupus to aid in early diagnosis, treating and monitoring patients with mild disease, recognizing warning signs to refer to a rheumatologist appropriately, and helping to monitor disease activity and treatment in patients with moderate to severe disease.3
Preventable lupus hospitalizations were more likely in minority patients over 40 years of age with public health insurance. A study that reviewed 23,154 total lupus hospitalizations found that 2,094 (9.04%) were preventable. Based on an adjusted model, the highest odds for a preventable lupus hospitalization were in minorities aged ≥65 years (odds ratio [OR] 2.501, confidence interval [CI] [1.501, 4.169]), minorities aged 40-64 years (OR 2.248, CI [1.394, 3.627]), minorities with Medicare insurance (OR 1.669, CI [1.353,2.059]), and minorities with Medicaid insurance (OR 1.662, CI [1.321, 2.092]). Authors speculate that poor access to primary care in these populations contributes to the higher likelihood of preventable hospitalization in people with lupus.4 This research reinforces the importance of working with both a rheumatologist and a PCP if you have lupus.
References
- Vorvick LJ. Choosing a primary care provider. MedlinePlus. Published July 19, 2021. Accessed June 7, 2019. https://medlineplus.gov/ency/article/001939.htm.
- Shi L. The impact of primary care: a focused review. Scientifica (Cairo). 2012;2012:432892. DOI 10.6064/2012/432892.
- Guidelines for referral and management of systemic lupus erythematosus in adults. American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines. Arthritis Rheum. 1999;42(9):1785-1796.
- Brown EA, Gebregziabher M, Kamen DL, White BM, Williams EM. Examining Racial Differences in Access to Primary Care for People Living with Lupus: Use of Ambulatory Care Sensitive Conditions to Measure Access. Ethn Dis. 2020;30(4):611-620.
