Relationships between knowledge and experience in the use of disease-modifying antirheumatic agents. A study of primary care practitioners

The timely dissemination of new medical information is a complex and often faulty process. We surveyed primary care physicians to determine their knowledge and use of disease-modifying antirheumatic agents for the treatment of rheumatoid arthritis. Only 26.2% of patients hospitalized for rheumatoid arthritis had been treated with disease-modifying antirheumatic agents in the past, and 13.9% were presently receiving them. When responding to a clinical vignette on rheumatoid arthritis, only 12% (10/84) of practitioners would implement therapy with disease-modifying antirheumatic agents, while the majority would refer the patient to a rheumatologist. Experience with similar patients was clearly the factor that led to initiation of therapy. While 73% of practitioners were aware of the value of disease-modifying antirheumatic agents, only 14% prescribed them in the last year. These findings suggest that dissemination of information concerning disease-modifying antirheumatic agents has been successful, but the problems inherent in their use result in referral rather than initiation of therapy.