Abstract
Background: Considering the importance of getting the right patient at the right location to maintain and optimize quality of life of inflammatory arthritis patients, appropriate referral by general practitioners is essential. This study aims to assess the effect and cost effectiveness of different referral strategies for inflammatory arthritis in primary care patients. Methods: This study follows a cluster randomized controlled trial design. General practitioners from primary care centers in Southwest-The Netherlands are randomly assigned to either one of the two strategic interventions for referring adult patients who are in the opinion of the general practitioner suspected of inflammatory arthritis: 1) Standardized digital referral algorithm based on existing referral models PEST, CaFaSpA and CARE; 2) Triage by a rheumatologist in the local primary care center. These interventions will be compared to a control group, e.g. usual care. The primary outcome is the percentage of patients diagnosed with inflammatory arthritis by the rheumatologist. Secondary outcomes are quality of life as a patient reported outcome, work participation and healthcare costs. These data, including demographic and clinical parameters, are prospectively collected at baseline, three, six, and twelve months. Discussion: If this study can demonstrate improvements in appropriate referrals to the rheumatologist, thereby improving cost-effectiveness, there is sufficient supporting evidence to implement one of the referral strategies as a standard of care. Finally, with these optimization strategies a higher quality of care can be achieved, that might be of value for all patients with arthralgia. Trial Registration: NCT03454438, date of registration: March 5, 2018. Retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT03454438?term=NCT03454438&draw=1&rank=1.
Highlights
Considering the importance of getting the right patient at the right location to maintain and optimize quality of life of inflammatory arthritis patients, appropriate referral by general practitioners is essential
This study aims to assess the effect and cost effectiveness of different referral strategies for inflammatory arthritis in primary care patients
General practitioners from primary care centers in Southwest-The Netherlands are randomly assigned to either one of the two strategic interventions for referring adult patients who are in the opinion of the general practitioner suspected of inflammatory arthritis: 1) Standardized digital referral algorithm based on existing referral models PEST, CaFaSpA and CARE; 2) Triage by a rheumatologist in the local primary care center
Summary
A substantial part of the general population in the Netherlands and worldwide is affected by musculoskeletal complaints (MSC) [1] [2]. Because the GP sees such a large heterogeneity of patients with MSC, it has proven to be difficult to recognize those patients at risk of IA [5] [6] This is reflected by the low percentage of IA in patients referred to the rheumatology outpatient clinic. Integrated care, in which primary and secondary care bundle their expertise to improve the accessibility, quality and efficiency of care, may be a solution to this problem This is in line with the principles of value based health care (VBHC), e.g. maximizing value for patients. Studies have revealed that the use of these shifted outpatient clinics leads to improved accessibility [11], equal quality of care [12], improved patient satisfaction, reduced waiting times and considerable cost savings to patients [13]. It is suggested to have great potential to improve appropriateness of patient referral to rheumatology centers
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