P047 Analysis of advice and guidance primary care queries to rheumatology over a calendar year - a mixed methods approach

Background/Aims In the United Kingdom, Advice and Guidance (A&G) services allow general practitioners (GPs) to seek consultant assistance without formal referral, supporting decision-making and reducing unnecessary secondary care demand. However, a significant proportion of A&G queries represent frequently asked questions (FAQs), placing avoidable burden on consultants and delaying patient care whilst replies are awaited. This first of its kind pilot project aimed to identify common FAQs within rheumatology A&G queries at Morecambe Bay Hospitals Trust (MBHT), with the goal of developing targeted educational material. This guidance is to be accessed immediately before GPs make an A&G query in an attempt to answer FAQs before they are submitted. Methods We conducted a retrospective, mixed-methods content analysis of 2,499 GP-initiated rheumatology A&G messages submitted between April 2024 and April 2025. Our analysis occurred in three stages. Firstly, we performed a word-frequency analysis to identify common, clinically significant phrases within A&G queries. Next, for each often-occurring term in our frequency map, we drew a purposive sample of the full A&G conversation in which it appeared. From these, we conducted an in-depth, iterative coding of their content, identifying and refining sub-themes until no new themes emerged. Finally, we filtered the dataset for messages containing ‘urgent,’ ‘acute,’ or ‘emergency’ to isolate time-sensitive queries. Results Three major themes of FAQ emerged: interpretation of blood tests (especially incongruous blood results and the significance of inflammatory markers), management of osteoporosis (particularly medication queries), and initial treatment or diagnostic uncertainty in suspected giant cell arteritis (GCA). Queries marked as urgent were most commonly associated with GCA. GPs’ questions were frequently similar within their themes and amenable to concise, standardised advice. Conclusion Recurring patterns in A&G queries suggest an opportunity to support local GPs through focused educational material; a guidance document targeting the most common FAQs is in development. Although implementation and evaluation are pending, this low-cost, scalable approach may feasibly offer value across specialties and sites. Further study will assess its impact on A&G usage and GP confidence.