Abstract
BackgroundReferral letters from primary care contain a large amount of information that could be used to improve the appropriateness of the referral pathway for individuals seeking specialist opinion for knee or hip pain. The primary aim of this study was to evaluate the content of the referral letters to identify information that can independently predict an optimal care pathway.MethodsUsing a prospective longitudinal design, a convenience sample of patients with hip or knee pain were recruited from orthopaedic, specialist general practice and advanced physiotherapy practitioner clinics. Individuals completed a Knee or hip Osteoarthritis Outcome Score at initial consultation and after 6 months. Participant demographics, body mass index, medication and co-morbidity data were extracted from the referral letters. Free text of the referral letters was mapped automatically onto the Unified Medical Language System to identify relevant clinical variables. Treatment outcomes were extracted from the consultation letters. Each outcome was classified as being an optimal or sub-optimal pathway, where an optimal pathway was defined as the one that results in the right treatment at the right time. Logistic regression was used to identify variables that were independently associated with an optimal pathway.ResultsA total of 643 participants were recruited, 419 (66.7%) were classified as having an optimal pathway. Variables independently associated with having an optimal care pathway were lower body mass index (OR 1.0, 95% CI 0.9 to 1.0 p = 0.004), named disease or syndromes (OR 1.8, 95% CI 1.1 to 2.8, p = 0.02) and taking pharmacologic substances (OR 1.8, 95% CI 1.0 to 3.3, p = 0.02). Having a single diagnostic procedure was associated with a suboptimal pathway (OR 0.5, 95% CI 0.3 to 0.9 p < 0.001). Neither Knee nor Hip Osteoarthritis Outcome scores were associated with an optimal pathway. Body mass index was found to be a good predictor of patient rated function (coefficient − 0.8, 95% CI -1.1, − 0.4 p < 0.001).ConclusionOver 30% of patients followed sub-optimal care pathway, which represents potential inefficiency and wasted healthcare resource. A core data set including body mass index should be considered as this was a predictor of optimal care and patient rated pain and function.
Highlights
Referral letters from primary care contain a large amount of information that could be used to improve the appropriateness of the referral pathway for individuals seeking specialist opinion for knee or hip pain
A consecutive sample of patients with hip and or knee pain that had been referred by their general practice for specialist opinion were screened for inclusion from orthopedic surgeon led orthopaedic clinics, specialist general practitioner clinics and advanced physiotherapy practitioner clinics
The primary aim of this study was to identify factors from GP with specialist interest in musculoskeletal disorders (GP) referral letters that can predict which patients with knee and/or hip pain would receive an optimal care pathway at the time of consultation
Summary
Referral letters from primary care contain a large amount of information that could be used to improve the appropriateness of the referral pathway for individuals seeking specialist opinion for knee or hip pain. The current recommended pathway for long term conditions, including adults with knee and hip pain, is management in primary care and referral to a multi-professional assessment and treatment clinic if specialist opinion is required [1,2,3]. There are a number of variations in the current care pathway, which represent potential inefficiency in resource use and standards of care [4] and importantly delay for patients [5] This includes variation in where clinics are based, what profession assesses and treats patients and in the care given [5,6,7]. An optimal outcome from a surgical consultation based on individual circumstances would be a referral for surgery, whereas sub-optimal outcome would be no definitive treatment
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
