PhD defence E.T.A.M. (Elke) van Delft

Summary: Getting the right patients at the right location and caregiver is essential to maintain and optimize quality of life in patients with musculoskeletal complaints. For patients with non-inflammatory complaints this entails averting inappropriate referral towards expensive hospital care. For patients with an inflammatory rheumatic disease (IRD) this entails timely referral towards a rheumatologist within secondary care to initiate treatment as early as possible. 
We have shown that the proportion of IRD in patients referred to the rheumatology outpatient department is low. Over 70% of patients are inappropriately referred towards expensive rheumatology care, presenting us with a challenge. 
A possible solution to this challenge is implementation of a structured digital referral sheet. There are already existing referral sheets that show a net benefit in the recognition of IRD compared to usual care. Facilitators towards implementation of such a referral sheet encompass a strong support base, the ability to increase awareness and knowledge on IRD, and organizing care around the patient. To efficiently make use of a referral sheet, it should be used by general practitioners within primary care.
Another possible solution is triage by a rheumatologist in a primary care setting. We have shown that the proportion of IRD diagnoses in referred patients increases when using triage. Next to that, healthcare utilization decreases, quality of life increases, and triage has shown to be more cost-effective compared to usual care.