Joint consultation of general practitioner and rheumatologist: does it matter?

Abstract

Objective: To assess the effects of joint consultation on referral behaviour of general practitioners (GPs) in a prospective cohort study. Methods: All patients with rheumatological complaints that 17 participating GPs, from the area of the University Hospital Maastricht, wanted to refer during a two year inclusion period (n=166) were eligible for inclusion. These patients were either referred to the outpatient clinic, or presented at a joint consultation held every six weeks at the practice of the GP, where groups of three GPs presented their patients to a visiting, consulting rheumatologist. The number of patients referred by each GP a year at the end of the trial, comparing participating and non-participating GPs, was the main outcome measure. Results: During two years of inclusion, the 17 participating GPs presented 166 patients. The number of patients referred by each GP a year decreased for the participating GPs by 62% at the end of the whole study. By contrast, non-participating GPs maintained the same rate of referral. The range of diagnoses remained proportionally the same throughout the study, with the exception of fibromyalgia. The referral rate of this diagnosis decreased significantly (p=0.001). Conclusions: Joint consultation seems to be a good strategy in influencing the referral behaviour of GPs in the area of rheumatology. The decrease in referral is substantial and can subsequently lead to a reduction of waiting lists.

Referral interventions from primary to specialist care: a systematic review of international evidence

“…System change interventions included the community provision of specialist services by GPs (n = 9), [108][109][110][111][112][113][114][115][116][117] outreach or community provision by specialists (wholescale provision of a hospital service within the community) (n = 10), [118][119][120][121][122][123][124][125][126][127] return of inappropriate referrals (n = 2), 128,129 the provision of additional primary care staff (n = 3), [130][131][132] the addition or removal of gatekeeping systems (requiring a primary care provider to give access to secondary care services) (n = 4), [133][134][135][136] changes to payment systems (n = 4), [137][138][139] and referral management centre or other major triage systems (n = 6). [140][141][142][143][144][145][146] The overall picture for interventions that aim to implement large system changes to impact on referral is mixed.…”

Republished: A systematic literature review of strategies promoting early referral and reducing delays in the diagnosis and management of inflammatory arthritis

“…All reported some success in terms of improved awareness, knowledge and ability to detect IA and quality of the referral process 31–38. One described a continuing medical education (CME) initiative to educate PCPs on the benefits of screening and diagnosing patients with suspected RA and co-managing them with a specialist 35.…”

System Integration and Clinical Utilization of the Advanced Clinician Practitioner in Arthritis Care (ACPAC) Program–Trained Extended Role Practitioners in Ontario: A Two-Year, System-Level Evaluation

“…Deficiencies of the referral process from primary care provider to rheumatologist have been documented elsewhere [63][64][65][66] . Most authors agree that high frequency, inappropriateness and delays in referrals contribute to increased waiting times and compromise the quality of health care 66,67 .…”

“…The median time between symptom onset to DMARD initiation was over six months with delays in the identification of inflammatory arthritis and referral to a rheumatologist being a key contributor. Several studies have highlighted potential solutions to ensuring timely care, including, the improved communication between GPs and specialists 66 , joint consultation between GPs and rheumatologists to influence the referral behaviour of GPs to decrease referral and potentially lead to a reduction of waiting lists 67 , and diagnostic triage by GPs, Registered Nurses, or other appropriately trained health professionals have been posed as ways to regulate frequency and appropriateness of referrals 72 .…”

“…Approximately half of respondents of this survey were involved in new emerging models of care. In the literature, in addition to a joint-consultation model 67 , several other models of care have emerged for the treatment of arthritis and rheumatism. These include team care 73 and the use of expanded role practitioners 74 .…”