E46. SURVEY OF RHEUMATOLOGY REFERRALS FROM PRIMARY CARE IN SOUTHPORT HOSPITAL

Abstract

Background: Referrals from Primary care to Rheumatology Out Patient services for diagnosis of inflammatory rheumatological conditions have been increasing overburdening secondary care resources. We felt it was important to study the nature of referrals, indication in the referral letter and final diagnosis in clinic, waiting period from time of referral, and ratio of follow up of new patients. This was done to streamline the referral pathway from primary care in order to ensure that the best possible care was provided in a timely fashion with optimal use of resources. Methods: It was a retrospective survey of referrals for new patients seen in a single consultant clinic during a three-month period between February 2016 and May 2016. Data were collected through clinic letters and their corresponding GP referral letters, results of investigations. Results: 159 New patients were seen of which 34 were Males and 125 were females. 42 were referred as early inflammatory arthritis, 14 for possible connective tissue disease, 12 each for crystal arthritis and spondyloarthritis. Youngest patient was 16yrs and oldest was 90yrs. 29 patients were diagnosed with inflammatory rheumatological conditions and 7 were possible inflammatory conditions. Out of 29 patients 3 were referred for transfer of care from other hospitals. 64 patients were seen within 6 weeks and 71 patients were seen between 7 to 12 weeks and remaining 24 patients were seen between 12 to 20 weeks. 91 patients were discharged after first consultation, 35 had follow up arranged, 23 were given open appointment. After the clinic, 43 patients were diagnosed with fibromyalgia, 29 with musculoskeletal pain, 26 with osteoarthritis. Diagnoses after clinic Conclusion: Most of patients referred as inflammatory condition did not get diagnosed with inflammatory rheumatological condition. Out of 8 patients seen in connective tissue disease, 4 turned out to be primary Raynaud's. Polymyalgia rheumatica diagnoses were correct. Diagnosis of fibromyalgia is more common in secondary care. We arranged education sessions to GPs to adhere to early arthritis referral proforma. More awareness and training is required in primary care regarding diagnoses and management of fibromyalgia, generalized osteoarthritis, osteoporosis, gout and use of musculoskeletal services. Rheumatologists in collaboration with BSR should consider conducting educational courses for primary care practitioners.