Ab1833-Hpr study of the Demand for Referrals From Primary Care to the Rheumatology Department of a Tertiary Hospital

Abstract

BackgroundEPISER study has confirmed the great burden of rheumatic diseases, which represent almost 30% of primary care medical consultations in Spain[1,2]. Electronic consultation could be an alternative response[3]as well as rheumatologist-led update programmes and joint case discussion with primary care physicians have shown to reduce the burden of care and waiting times in rheumatology units[4].ObjectivesTo analyze the demand from primary care to the rheumatology service of a tertiary hospital.MethodsRetrospective descriptive study of the data consecutively collected from 15 to 30 May 2022 from new rheumatology consultations at the reference hospital requested from primary care (PC) health centers in the area. The following variables were collected: waiting time (median and range in days), referral route (ordinary, preferential or e-consultation), reason for derivation, type of visit (discharge or follow-up), suspicion of inflammatory disease by the specialist in Family and Community Medicine (Yes/No), confirmation diagnosis of inflammatory disease by the specialist in Rheumatology (Yes/No), time from onset of inflammatory symptoms to rheumatology consultation (median and range in months), referral with analytical tests (Yes/No/With acute phase reactants) and with musculoskeletal image requested by the PC physician (Yes/No); those provided by patients in private centers were excluded. Descriptive statistics were used for the presentation of results and Cohen’s Kappa coefficient was calculated to quantify the degree of agreement in the diagnosis of inflammatory disease between primary care physicians and rheumatologists.ResultsA total of 116 new consultations were registered in the system referring to 100 patients, 16 did not attend their appointment. Results are shown inTable 1. The degree of agreement according to Cohen’s Kappa index was 0.53, representing 80% of agreement (moderate degree). No differences were found between health care centers in the referral rate according to the population assisted by each health care center.ConclusionMain reasons for consultation were ‘osteoporosis assessment’ and ‘polyarthralgias’. Ordinary route was the most frequently used with a median waiting time of 80 days and 50 days for preferential route. Thirty percent of patients were referred with analysis and 75% with some musculoskeletal image. The degree of agreement was moderate in the diagnosis of inflammatory disease between primary care physicians and rheumatologists.References[1] Carmona L et al. The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. Ann Rheum Dis 2001 -11;60(11):1040-1045.[2] Seoane-Mato D et al. Frequency of medical visits due to osteoarticular problems of the adult general population in Spain. EPISER2016 Study. Gac Sanit 2020 Sep - Oct;34(5):514-517.[3] Pego-Reigosa JM et al. Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology. BMC Health Serv Res 2022 -01-12;22(1):60.[4] Surís X et al. A rheumatology consultancy program with general practitioners in Catalonia, Spain. J Rheumatol. 2007 Jun;34(6):1328-31.Table 1.Description of variablesWaiting time in days (median (range))OrdinaryPreferentiale-consultation79 (159)50 (150)35 (58)Referral route (%)OrdinaryPreferentiale-consultation73234Reason for derivation (%)OsteoporosisPolyarthralgiaArthrosisRheumatoid arthritisSpondyloarthritisFibromyalgiaGoutLow back painPolymyalgia rheumaticaPsoriatic arthritisRaynaud’s phenomenonOther221798854432119Type of visit (%)DsichargeFollow-up1882Suspicion of inflammatory disease by the specialist in Family and Community Medicine (%)38Confirmation diagnosis of inflammatory disease by the specialist in Rheumatology (%)20Time from onset of inflammatory symptoms to Rheumatology consultation in months (median (range))13 (44)Additional tests (%)Analysis (with PCR and VSG)Musculoskeletal image3175Acknowledgements:NIL.Disclosure of InterestsNone Declared.