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Transforming patient outcomes: early diagnosis of axial spondyloarthritis (axSpA)

PRIMIS' axSpA pop-up alert tool is designed to seamlessly integrate with EMIS Web and TPP SystmOne GP IT systems. This innovative tool empowers healthcare professionals to identify axSpA earlier, potentially reducing diagnostic delays and accelerating treatment.

The tool is being introduced as part of a movement to improve patient care with the' Act on Axial SpA' campaign, spearheaded by the National Axial Spondyloarthritis Society (NASS).

With the support of NASS, practices from the Southwest Axial Spondyloarthritis Group (SWAG) and the Bedford, Luton and Milton Keynes (BLMK) localities, with their respective consultant rheumatologist and clinical teams, will monitor the effectiveness and acceptability of this approach.

NASS

A powerful collaboration

The original model was developed by PRIMIS in partnership with Dr. Raj Sengupta, Consultant Rheumatologist at Royal United Hospitals Bath NHS FoundationTrust, with the support of Novartis Pharmaceuticals UK Ltd, with an aim to transform the current diagnostic landscape.

Reducing diagnostic delays

According to NASS, the average time to diagnose axSpA is more than eight years, a delay that often leads to irreversible spine damage. The PRIMIS alert tool significantly shortens this time, enabling healthcare providers to:

  • quickly refer patients for timely intervention
  • initiate treatment sooner, reducing the risk of long-term damage and improving patient outcomes

The tool is designed with clinicians in mind, offering intuitive, non-intrusive support that enhances decision-making without adding extra workload. With carefully crafted trigger criteria it ensures that only the most accurate and relevant alerts are triggered, supporting more precise diagnoses and better care for patients.

Real-world impact

Dr. Raj Sengupta explained: “During the initial trial in GP practices, the tool was shown to be both easy to use and highly effective. Despite the low prevalence of axSpA, when the alert triggers, it leads to faster, more accurate diagnoses and ultimately better patient care.”

Comprehensive reporting for continuous improvement

The associated reporting tools offer valuable insights:

  • frequency of alerts and clinician responses, including referrals and diagnoses
  • retrospective population searches for patients who meet the alert criteria and may have undiagnosed axSpA but haven’t yet attended a consultation.

The SWAG/BLMK AxSpA Programme, sponsored by NASS, will leverage these reports to:

  • monitor the effectiveness of in-consultation alerts for axSpA detection
  • proactively identify patients for further assessment through retrospective searches and self-assessment questionnaires

Additionally, the previous cohort of early adopters will continue to benefit from ongoing access to the toolkit, ensuring sustained impact across practices.

Unlocking the future of axSpA diagnosis

This pilot will contribute to a nationwide effort to diagnose and treat axial spondyloarthritis earlier, helping patients live healthier, more active lives.

Are you a practice involved in the pilot?

The axSpA alert and template have been developed to assist in GP or First Contact Physiotherapist consultations where any underlying inflammatory cause of back pain is being considered and to help decide whether to be suspicious of inflammatory back pain (IBP).

It has been designed to be non-intrusive and is carefully optimised to avoid alert fatigue. The axSpA alert and template are only launched when a specific combination of existing codes combined with those entered in a consultation are detected.

The pop-up alert is activated where:

  • the patient is aged between 18 and 44 years old
  • back pain previously recorded in notes in the past 3 - 12 months
  • back pain in entered today in the current open consultation

Unless the patient:

  • is recorded as being on palliative care register
  • has an existing Dx of axSpA
  • has been referred to (or seen by) Rheumatology or back pain clinic in the past year
  • has already assessed for axSpA (using the tool)

Please watch the following video explaining how the tool works:

 

The project will be initiated with a one-off baseline search using the toolkits reporting tool to identify patients that would meet the alert criteria if they attended a consultation on the same day the search was run.

These patients will be sent a link to the NASS symptom checker so that eligible patients can be identified and referred without delay.

This will also provide anonymised summative data to enable an assessment of the effectiveness and user acceptability of the alert.