Background Clinical Specialist Physiotherapy roles were developed in Ireland in 2012 as part of the National clinical care programs. A Rheumatology triage post was assigned to the South /South West group. The Musculoskeletal Assessment Clinic (MAC) runs across two sites the South Infirmary Victoria University Hospital (SIVUH) and Cork University Hospital (CUH). Triage by physiotherapists has been running in other parts of the world for a number of years with favourable outcomes in terms of patient experiences, GP satisfaction and diagnostic accuracy (1). Patients are triaged to the MAC by the Rheumatology consultant based on information supplied in the GP referral letter indicating non inflammatory conditions. These include mechanical neck and back pain, OA and soft tissue rheumatism suitable for injection therapy.
Objectives The objective of this of this audit was to establish (1) the number of patients seen at MAC (b) number of referrals onwards to the Rheumatology consultant led clinics from MAC, (c) to assess the appropriateness of these onward referrals (d) the rate of re-referral to the rheumatology service of patients assessed at the MAC Rheum and discharged.
Methods A retrospective audit of GP referrals to the Rheumatology service triaged to MAC between July 2012 and October 2015 was undertaken.
Results 1,297 new patients were assessed at the MAC between July 2012 and October 2015. 92% were managed by the triage physiotherapist without seeing the Rheumatology team although in some cases the physiotherapist did consult with the Rheumatology consultant at initial assessment. 8% (98 Patients) were referred to a Rheumatology consultant led clinic for assessment. Of these 49% (48) were confirmed as having an inflammatory arthritis, 39% (38 patients had a variety of other diagnoses requiring medical review including SLE,CREST, Paget's, new vertebral fracture and CPPD. The remaining 12% (12 patients) were diagnosed as OA on review and discharged. At the time of audit 4% (55 patients) had been re-referred to the service. 2% (1 patient) was assessed by the Rheumatology consultant and diagnosed as having an inflammatory arthritis. 25% (14 patients) were reviewed at MAC and discharged, 22% (12 patients) were reviewed by consultant and discharged. 4% (2 patients) DNA follow up appointment. 47% (26) were still awaiting routine review with consultant.
Conclusions 92% of patients triaged to the MAC were assessed and managed by the triage physiotherapist without the need for review by the Rheumatology team. The low rate of onward referral (8%) from MAC to Rheumatology and of re-referral (4%) to the Rheumatology service would appear to indicate the patients triaged to the MAC are appropriate for that pathway. Of the patients referred on to the consultant clinic 88% required input by the Rheumatology team. This initiative helps reduce OPD waiting times for specialist services by reducing the time spent by the Rheumatology team on non inflammatory mechanical disorders. GP satisfaction and patient experience surveys are currently being undertaken and the results will be included in the presentation.
Maddison, P et al. Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) programme. BMJ. 2004 Dec 4; 329(7478): 1325–1327. doi: 10.1136/bmj.329.7478.1325 PMCID: PMC534845
Disclosure of Interest None declared