PMID- 36173970
OWN - NLM
STAT- MEDLINE
DCOM- 20230614
LR  - 20230615
IS  - 1502-7732 (Electronic)
IS  - 0300-9742 (Linking)
VI  - 52
IP  - 4
DP  - 2023 Jul
TI  - Impact of triage by a rheumatologist on appropriateness of referrals from primary 
      to secondary care: a cluster randomized trial.
PG  - 403-411
LID - 10.1080/03009742.2022.2112833 [doi]
AB  - OBJECTIVE: The quality of referrals is often criticized, and the effectiveness of 
      improvement efforts remains uncertain. We assessed the impact of a rheumatologist 
      triaging patients in primary care on the appropriateness of referrals to 
      secondary care, healthcare utilization, and patient experience and outcomes. 
      METHOD: A cluster randomized controlled trial was conducted with patients 
      experiencing musculoskeletal complaints. Intervention practices deployed an 
      experienced rheumatologist triaging patients through in-person review. Usual care 
      was performed in control practices, where practitioners referred patients based 
      on their own judgement. The primary outcome was the proportion of inflammatory 
      rheumatic diseases (IRDs) diagnosed by rheumatologists in referred patients. 
      Healthcare utilization (iMTA Medical Consumption Questionnaire), quality of life 
      (EuroQol 5 Dimensions), and experience of care (Consumer Quality Index) were 
      determined after 3 months of follow-up. Data were analysed according to the 
      intention-to-treat principle. RESULTS: In total, 544 participants were included 
      [mean age 51.4 (range 18-87) years; 24% were men]. Of all referred patients, 51% 
      had an IRD in the intervention group versus 21% in the control group (p = 0.035). 
      After 3 months of follow-up, patients from the triage intervention showed lower 
      healthcare utilization (p = 0.006) and higher quality of life (p = 0.011), 
      without a decline in experienced quality of care (p = 0.712), compared to 
      controls. CONCLUSION: Triage by a rheumatologist in primary care provides 
      appropriate care and adequate experience of care, leading to a higher quality of 
      life. Long-term evidence is needed to assess the value on cost-effectiveness 
      before implementing this strategy nationwide.
FAU - van Delft, Etam
AU  - van Delft E
AUID- ORCID: 0000-0002-3744-1171
AD  - Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands.
FAU - Lopes Barreto, D
AU  - Lopes Barreto D
AUID- ORCID: 0000-0003-3143-4883
AD  - Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands.
FAU - Han, K H
AU  - Han KH
AD  - Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands.
FAU - Tchetverikov, I
AU  - Tchetverikov I
AUID- ORCID: 0000-0001-7870-8330
AD  - Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The 
      Netherlands.
FAU - Evertse, A
AU  - Evertse A
AD  - Medical Center Molenaar, Oud-Beijerland, The Netherlands.
FAU - Kuijper, T M
AU  - Kuijper TM
AUID- ORCID: 0000-0002-2834-5727
AD  - Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands.
FAU - Hazes, Jmw
AU  - Hazes J
AD  - Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands.
FAU - Weel-Koenders, Aeam
AU  - Weel-Koenders A
AUID- ORCID: 0000-0002-1831-5129
AD  - Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands.
AD  - Health Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20220929
PL  - England
TA  - Scand J Rheumatol
JT  - Scandinavian journal of rheumatology
JID - 0321213
SB  - IM
MH  - Male
MH  - Humans
MH  - Adolescent
MH  - Young Adult
MH  - Adult
MH  - Middle Aged
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - *Secondary Care
MH  - *Rheumatologists
MH  - Triage
MH  - Quality of Life
MH  - Referral and Consultation
MH  - Cost-Benefit Analysis
EDAT- 2022/09/30 06:00
MHDA- 2023/06/14 06:42
CRDT- 2022/09/29 15:04
PHST- 2023/06/14 06:42 [medline]
PHST- 2022/09/30 06:00 [pubmed]
PHST- 2022/09/29 15:04 [entrez]
AID - 10.1080/03009742.2022.2112833 [doi]
PST - ppublish
SO  - Scand J Rheumatol. 2023 Jul;52(4):403-411. doi: 10.1080/03009742.2022.2112833. 
      Epub 2022 Sep 29.