Background The high prevalence of rheumatic and musculoskeletal diseases (Ref 1) along with the limited resources allocated to the specialty of rheumatology, has made us think about new models of care. A mixed virtual and face-to-face rheumatology consultation, working together Lo Morant's Health Center (HC) and the Rheumatology Section of Alicante Hospital, began to work in May-2014. (Ref 2).
Objectives To analyse the causes of consultation from primary care to rheumatology, the distribution of the pathologies and the way they were resolved.
Methods The primary care physician (PCP) made a virtual consultation (VC) to the rheumatologist within the electronic record system “Abucasis”. Once a month, the rheumatologist and one of the PCP attended a face-to-face consultation (F2F) in the HC. The same day, a formative-informative session took place in the HC with rheumatologist and PCPs attendance. Variables recorded: Number of patients, VC, F2F, technics performed, diagnosis and attitude. STATISTICAL ANALYSIS: Descriptive variables.
Results The period between May-2014 to December-2015 was analysed. 806 consultations (607 VC, 199 F2F, 537 patients), were performed. After VC, 75 patients (13,9%) were referred to specialised rheumatology consultation (SRC), but 280 were resolved (52,1%, 132 mechanical problems (47,1%), 51 osteoporosis (18,2%), 40 tendinitis (14,2%), 12 fibromyalgia (4,3%), 8 microcrystal diseases (2,8%), 5 inflammatory/autoimmune (1,7%), 5 no disease (1,7%), 21 were referred to other speciality (7,5%)). In F2F, 181 patients were attended (33,7%), 21 joint aspiration with microscopic synovial fluid exam, and 104 local injections were performed, 13 patients were referred to other speciality, and 31 were referred to SRC. The final diagnostics of the 106 patients referred to SRC were: 24 mechanical and tendinosus problems (22,8%), 22 chronic arthritis (20,9%), 21 microcrystal diseases (20%), 12 autoimmune diseases (11,4%), 9 severe osteoporosis (8,5%), 2 cancers, 2 no disease, 1 Sudeck atrophy, 1 neuropathy.
Comments:VC avoided displacement of 301 patients (280 resolved, 21 referred to appropriate speciality), reducing the lost of working days and displacement costs, and diminishing SRC load. Minor problems (soft tissue and mechanic problems) were usually resolved in F2F of HC, while severe and inflammatory pathologies were mainly referred to SRC, where chronic patients are managed.
Conclusions Mixed rheumatology consultation is very effective, avoids unnecessary patients displacements, and makes easier the appropriate level of attendance of pathology. Continuing education in primary care and tight relationship with rheumatologist allowed a better referral of patients, reserving SRC for more severe and complicated situations that required it.
WHO. The burden of muskuloskeletal conditions at the start of the new millenium. 2003.
Vela P et al. Resultados preliminares de un modelo mixto virtual-presencial de consulta de reumatología: una propuesta de cambio de modelo asistencial. XLI Congreso Nacional de la Sociedad Española de Reumatología. Reum Clin 2015; 11:76.
Disclosure of Interest None declared