Background Primary care networks of health professionals (HPs) are instituted to improve the quality of care for patients with rheumatic and musculoskeletal diseases (RMDs). So far, research into their organization and outcomes is limited.
Objectives To describe the characteristics of primary care rheumatology networks in the Netherlands, and satisfaction of patients with RMDs treated by network members.
Methods Through the Internet and personal communication, existing primary care rheumatology networks were identified. Data on network characteristics were collected by interviewing network coordinators, and an online questionnaire for all network members (organizational aspects, education, patient load, and satisfaction). Members were asked to invite max. 4 patients to complete an online satisfaction questionnaire (Consumer Quality Index (CQ) subscales: Information, Attitude of HPs, Cooperation and Self-management (range 1–4)), and grading satisfaction (range 1–10). Satisfaction scores of patients treated within the networks were compared with aggregated data from a national dataset of 1648 patients treated in 45 physiotherapy (PT) practices using unpaired Students' T-tests.
Results 19 rheumatology networks were identified, with 5 having an organizational structure, 17 networks set membership criteria, in 7 a fee was imposed. In 10 networks patients were involved, and 17 collaborated with a hospital rheumatology department. There were 479 network members (median 18 per network, range 7–106), with 15 including only PTs, 18 organized network meetings for professionals and 11 for patients. Communication within the network and with referring rheumatologists was scored as insufficient by 7 and 6 network coordinators, respectively, whereas all expressed the need for central support regarding network organization and activities. 214 network members returned the online survey, 38% had taken part in accredited postgraduate education on RMDs, 21% had seen no patients with Rheumatoid Arthritis, Osteoarthritis or Spondylarthropathy in the past year. Standardization of postgraduate education and organizational requirements for networks was desired by 70–80% of the members. 149 patients returned the survey. Compared to the reference set the patients treated in the rheumatology networks were significantly more satisfied concerning CQ information (3.6 (SD 0.4) vs 3.8 (SD 0.3); CQ attitude of health professionals (3.8 (SD 0.3) vs 3.9 (SD 0.3); CQ cooperation and self-management (3.3 (SD 0.6) vs 3.5 (SD 0.5); and overall satisfaction (8.7 (SD 0.8) vs 8.4 (SD 1.1) (all p<0.001).
Conclusions There is a large variety concerning the structure and process of primary care networks focusing on the management of patients with RMDs in the Netherlands. Although their added value with respect to patient satisfaction is plausible, there is a need for standardization of postgraduate education and the organization of such networks on the national level.
Acknowledgement This study was financially supported by the Dutch Arthritis Association.
We are indebted to all HPs, patient representatives, rheumatologists, and other stakeholders for their valuable contribution to the project (interviews, surveys, group meetings and individual advices).
Disclosure of Interest None declared