Diagnostic Performance and Clinical Utility of Referral Rules to Identify Primary Care Patients at Risk of an Inflammatory Rheumatic Disease

Delft, Elke Theodora Antonia Maria van; Barreto, Deirisa Lopes; Mil, Annette H M van der Helm-van; Alves, Celina; Hazes, Johanna M. W.; Kuijper, M.; Weel, A.

doi:10.1002/acr.24789

Cited by 4 publications

(1 citation statement)

References 28 publications

(34 reference statements)

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“…The authors also introduced a composite referral rule for inflammatory rheumatic diseases, incorporating various parameters such as sex, age, joint features, and duration of symptoms. This composite rule exhibits increased diagnostic performance, suggesting its potential applicability in PC settings [ 127 ].…”

Section: Discussionmentioning

confidence: 99%

Management of Rheumatoid Arthritis in Primary Care: A Scoping Review

Inchingolo,

Fatone

et al. 2024

IJERPH

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Rheumatoid arthritis (RA) can lead to severe joint impairment and chronic disability. Primary care (PC), provided by general practitioners (GPs), is the first level of contact for the population with the healthcare system. The aim of this scoping review was to analyze the approach to RA in the PC setting. PubMed, Scopus, and Web of Science were searched using the MESH terms “rheumatoid arthritis” and “primary care” from 2013 to 2023. The search strategy followed the PRISMA-ScR guidelines. The 61 articles selected were analyzed qualitatively in a table and discussed in two sections, namely criticisms and strategies for the management of RA in PC. The main critical issues in the management of RA in PC are the following: difficulty and delay in diagnosis, in accessing rheumatological care, and in using DMARDs by GPs; ineffective communication between GPs and specialists; poor patient education; lack of cardiovascular prevention; and increase in healthcare costs. To overcome these criticisms, several management strategies have been identified, namely early diagnosis of RA, quick access to rheumatology care, effective communication between GPs and specialists, active patient involvement, screening for risk factors and comorbidities, clinical audit, interdisciplinary patient management, digital health, and cost analysis. PC appears to be the ideal healthcare setting to reduce the morbidity and mortality of chronic disease, including RA, if a widespread change in GPs’ approach to the disease and patients is mandatory.

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Section: Discussionmentioning

confidence: 99%

Management of Rheumatoid Arthritis in Primary Care: A Scoping Review

Inchingolo,

Fatone

et al. 2024

IJERPH

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A scoping review of triage approaches for the referral of patients with suspected inflammatory arthritis, from primary to rheumatology care

Biln,

Bansback,

Shojania

et al. 2024

Rheumatol Int

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Impact of triage by a rheumatologist on appropriateness of referrals from primary to secondary care: a cluster randomized trial

Delft

Barreto

Han

et al. 2022

Scandinavian Journal of Rheumatology

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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.

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Diagnostic Performance and Clinical Utility of Referral Rules to Identify Primary Care Patients at Risk of an Inflammatory Rheumatic Disease

Cited by 4 publications

References 28 publications

Management of Rheumatoid Arthritis in Primary Care: A Scoping Review

Management of Rheumatoid Arthritis in Primary Care: A Scoping Review

A scoping review of triage approaches for the referral of patients with suspected inflammatory arthritis, from primary to rheumatology care

Impact of triage by a rheumatologist on appropriateness of referrals from primary to secondary care: a cluster randomized trial

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