Referrals from general practice to an outpatient rheumatology clinic: Disease spectrum and analysis of referral letters

Our objective was to study the demographic characteristics of patients refe rred from general practitioners to a rheumatology outpatient clinic and to analyse the content and quality of the referral letters. During a 12-month period 346 randomly chosen referral letters of new patients from GPs to a r heumatology outpatient clinic were evaluated. The mean age of the 346 refer red patients (73.1% females and 26.9% males) was 45.5 years and 17.8% were 60 or older. Mean disease duration at the time of referral was 50.9 months (1-432 months). Only about 10% of the patients referred had a disease durat ion of 1 month or less. The current clinical problem was appropriately pres ented in 95% of the referral letters. In only 0.9% of referrals had there b een a prior phone consultation. Altogether, 95.1% of the referrals were as a result of diagnosis or treatment, and in nearly half the cases a diagnosi s of inflammatory rheumatic disease was suggested. Ln 23% of the letters th e result of clinical examinations were missing. Laboratory tests such as serum rheumatoid factor, antinuclear antibodies an d HLA-B27 were used by GPs to screen for rheumatic disease in general. A la ck of correlation between clinical manifestations and subsequently requeste d laboratory examinations was frequently found in the referral letters, exe mplified by the use of HLA-B27 in rheumatoid arthritis and serum rheumatoid factors in ankylosing spondylitis. These results show that among GPs the t hreshold for referring patients to a rheumatology outpatient clinic appears rather high, and that patients are subjected to long observation periods b efore referral. A more frequent use of phone consultations and an improveme nt in the diagnostic skills of GPs may positively influence the selection o f patients for referral and shorten the long waiting lists in rheumatology. This need for improvement was further strengthened by GPs' inappropriate u se of laboratory tests.