Referral decisions and its predictors related to orthopaedic care.  A retrospective study in a novel primary care setting

Autoři: Esther H. A. van den Bogaart aff001;  Marieke D. Spreeuwenberg aff001;  Mariëlle E. A. L. Kroese aff001;  Mark W. van den Boogaart aff003;  Tim A. E. J. Boymans aff003;  Dirk Ruwaard aff001
Působiště autorů: Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands aff001;  Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands aff002;  Department of Orthopaedic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227863


Due to the ageing population, the prevalence of musculoskeletal disorders will continue to rise, as well as healthcare expenditure. To overcome these increasing expenditures, integration of orthopaedic care should be stimulated. The Primary Care Plus (PC+) intervention aimed to achieve this by facilitating collaboration between primary care and the hospital, in which specialised medical care is shifted to a primary care setting. The present study aims to evaluate the referral decision following orthopaedic care in PC+ and in particular to evaluate the influence of diagnostic tests on this decision. Therefore, retrospective monitoring data of patients visiting PC+ for orthopaedic care was used. Data was divided into two periods; P1 and P2. During P2, specialists in PC+ were able to request additional diagnostic tests (such as ultrasounds and MRIs). A total of 2,438 patients visiting PC+ for orthopaedic care were included in the analysis. The primary outcome was the referral decision following PC+ (back to the general practitioner (GP) or referral to outpatient hospital care). Independent variables were consultation- and patient-related predictors. To describe variations in the referral decision, logistic regression modelling was used. Results show that during P2, significantly more patients were referred back to their GP. Moreover, the multivariable analysis show a significant effect of patient age on the referral decision (OR 0.86, 95% CI = 0.81–0.91) and a significant interaction was found between the treating specialist and the period (p = 0.015) and between patient’s diagnosis and the period (p ≤ 0.001). Despite the significant impact of the possibility of requesting additional diagnostic tests in PC+, it is important to discuss the extent to which the availability of diagnostic tests fits within the vision of PC+. In addition, selecting appropriate profiles for specialists and patients for PC+ are necessary to further optimise the effectiveness and cost of care.

Klíčová slova:

Diagnostic medicine – Magnetic resonance imaging – Orthopedic surgery – Osteoarthritis – Outpatients – Primary care – Surgeons – Ultrasound imaging


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