Joint consultation: a joint venture towards improving effectiveness of health care

Abstract

The history of out-patient hospital care is relatively brief GPs for follow-up. In the same health care model, the when compared with the longstanding history of in-patient effect of joint consultation on referral behavior by GPs to care. In Europe, most hospitals saw the first out-patient the rheumatology out-patient clinic of the hospital was clinics only 100 years ago, and most of them started as evaluated. Although back-referral to the GP did not seem vaccination facilities. Over the years, the growth of outsuccessful, a substantial reduction in the number of patient hospital care largely exceeded the growth of inreferrals of new patients to the rheumatology out-patient patient care. When it became clear in the late 1970s that clinic was noted in the same study [2]. health care was becoming unaffordable, the increasing The idea of joint consultation in rheumatology is not demand for, and relentless supply of, health care was new. In 1980, a 3-year project on the effects of specialized criticized. As a consequence, active governmental regularheumatology care in a primary health center serving tions were imposed to attempt cost containment in all 20,000 inhabitants was reported by the Swedish National Western countries. The introduction of co-payments, the Board for Health and Social Welfare. The project comreduction in the provisions in the insurance package, and bined joint consultations between GPs and a rheumatologlimitation of free access to secondary care aimed at ist for 2 or 3 h per week with multidisciplinary care by an regulating health care utilization from the increasingly occupational therapist (OT) for 20 h per week and a demanding consumers. At the same time, various systems physiotherapist (PT) for 30 h per week. It was concluded of budgeting were imposed to halt the medicalization and that team rheumatology care, including a follow-up and growing supply of health care. Increasingly, policy makers treatment program, could be provided without undue delay. required economic evaluations before registering and Moreover, few patients needed referral to the specialist’s reimbursing new treatments and procedures. clinic, thus relieving the hospital out-patient department Since that time, critical voices have been raised as to [3]. Since the report, various forms of regular joint whether expensive and highly specialized hospital care can consultations between rheumatologists and GPs have been be replaced by less expensive forms of health care with started in Sweden. As in the model described by Schulpen equal or even better effectiveness. In the present issue, and colleagues, the GP presented the patient while the Schulpen et al. [1] study back-referral to the general rheumatologist performed a re-examination and discussed practitioner (GP) as a means of relieving the out-patient the diagnosis. Unlike the model in Maastricht, a complete rheumatology clinics. To accomplish this, they test treatment program was proposed in co-operation with the whether joint consultation between the rheumatologist and OT and PT (and, sometimes, a social worker). The system the GP might be a platform for referring patients back to also included the advantage of being able to refer back some patients to GPs. Although this system of joint consultation was considered valuable, patient-friendly, and *Corresponding author. University Hospital Maastricht, Department of cost-effective, the joint consultations came to an end in Rheumatology, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. many areas when the organization of GPs was radically Tel.: 131-43-387-5026; fax: 131-43-387-5006. E-mail address: aboo@sint.azm.nl (A. Boonen). changed. In other areas of Sweden, the organization of