G J C Schulpen1, W P M Vierhout3, D M van der Heijde2, R B Landewé2, R A G Winkens1 and S van der Linden2
1 Department of Transmural Care, University Hospital Maastricht, Maastricht, The Netherlands
2 Department of Rheumatology, University Hospital Maastricht
3 Department of General Practice, Maastricht University
Objective: To assess the effects of joint consultation on referral behavior 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 behavior of GPs in the area of rheumatology. The decrease in referral is substantial and can subsequently lead to a reduction of waiting lists.