Quality of referrals to a rheumatology service before and after implementation of a triage system with telemedicine support

Abstract

Purpose To evaluate the quality of referrals for a first Rheumatology consultation at a tertiary care center in a southern Brazilian capital (Porto Alegre, RS), having as background findings from a similar survey performed in 2007/2008. Since then, our state has implemented referral protocols and a triage system with teleconsulting support exclusively for referrals from locations outside the capital, permitting a comparison between patients screened and not screened by the new system. Methods Physicians of the Rheumatology Service at Hospital Nossa Senhora da Conceição prospectively collected information regarding first visits over a 6-month period (Oct 2017 to March 2018). We recorded demographic characteristics, diagnostic hypotheses, date of referral, and the municipality of origin (within the state of Rio Grande do Sul). We considered adequate referrals from primary health care when a systemic autoimmune inflammatory disease (SIRD) was suspected at first evaluation by the attending rheumatologist. Results Three hundred fifty-seven patients/appointments were eligible for analysis (193 from the capital and 164 from small and medium towns). In 2007/2008, suspected SIRD occurred in 76/260 (29.2%) and 73/222 (32.9%) among patients from the capital and outside counties, respectively (P = 0.387). In 2017/2018, suspected SIRD occurred in 75/193 (38.9%) and 111/164 (67.7%) in patients from the capital and outside counties, respectively (difference: 28.8, 95% CI: 19.0 to 38.9, P < 0.001), indicating a marked improvement in referrals submitted to the new triage system. Conclusion The quality of Rheumatology referrals in our state improved over the 10-year interval under study, particularly among patients from locations submitted to referral protocols and teleconsulting support.

Referrals for Rheumatologic Evaluation Because of Positive Antinuclear Antibody: Analysis of a Retrospective Brazilian Cohort

“…There is a concern regarding the better management of referrals to the specialist, considering that most of cases of bromyalgia, osteoarthritis, and gout are referred for a rheumatological evaluation but could be followed in a primary health care. Although it has already been described that protocols associated with telemedicine can reduce inappropriate referrals to the specialist, it is clear that strategies that can optimize the waiting list are still needed [2]. A high percentage of patients referred had conditions that do not meet autoimmune rheumatic diseases criteria [2].…”

“…Although it has already been described that protocols associated with telemedicine can reduce inappropriate referrals to the specialist, it is clear that strategies that can optimize the waiting list are still needed [2]. A high percentage of patients referred had conditions that do not meet autoimmune rheumatic diseases criteria [2]. It is not well established what are the possible causes for this situation, but it seems to be most likely a multifactorial problem, including the lack of recognition of prevalent diseases and inadequate workup.…”