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Priority-setting tools for rheumatology disease referrals: a review of the literature

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Abstract

As part of a larger body of work to develop a rheumatology priority referral score, a literature review was conducted. The objective of the literature review was to identify preexisting priority-setting, triage, and referral tools/scales developed to guide referrals from primary care to specialist care/consultation usually provided by a rheumatologist. Using a combination of database, citation, Internet, and hand-searching, 20 papers were identified that related to referral prioritization in three areas: rheumatoid arthritis (RA; 5), musculoskeletal (MSK) diseases other than RA (3), and MSK diseases in general (12). No single set of priority-setting criteria was identified for rheumatologic disorders across the spectrum of patients who may be referred from primary care providers (PCPs) to rheumatologists. There appears to be more congruence on conditions at either end of the urgency spectrum with conditions such as suspected cranial arteritis or systemic vasculitis deemed to be emergency referrals and fibromyalgia and other soft-tissue syndromes deemed to be more routine referrals. Between these two extremes, there is a divergence of opinion about urgency and few papers on the issue. The exception to this is referral for early RA for which several criteria have been established. Despite the inherent complexities in developing a tool to prioritize patients referred by PCPs to rheumatologists, there are compelling reasons to proceed. With the aging of the population, the number of patients being referred to rheumatologists is expected to increase. With pharmaceutical advances, there are demonstrable benefits in early referral for some conditions. These trends have led to increased pressure on scarce rheumatological human resources. A tool to prioritize referrals is a critical component of improving access and the referral process.

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Acknowledgements

The Investigators of the Western Canada Waiting List Project are Eric Bohm (University of Manitoba), Michael Carter (University of Toronto), Barbara Conner-Spady (University of Calgary), Carolyn De Coster (Calgary Health Region and University of Calgary), Michael Dunbar (Dalhousie University), Gillian Hawker (Women’s College Hospital, University of Toronto), Diane Lorenzetti (University of Calgary), Claudia Sanmartin (Statistics Canada and University of Calgary), Sherry Weaver (University of Calgary), and Tom Noseworthy, Chair (University of Calgary). This work was funded by Alberta Health and Wellness—Access to Medical Services Grant. We thank Diane Lorenzetti and Claudia Sanmartin for their help in conducting the search and reviewing abstracts.

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Authors and Affiliations

  1. Health Outcomes, Calgary Health Region, 4520 16th Avenue NW, Calgary, Alberta, T3B 0M6, Canada

    Carolyn De Coster

  2. Department of Community Health Sciences, University of Calgary, Calgary, Canada

    Carolyn De Coster

  3. Department of Medicine, University of Calgary, Calgary, Canada

    Avril Fitzgerald

  4. Centre for Health and Policy Studies, University of Calgary, Calgary, Canada

    Monica Cepoiu

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  1. Carolyn De Coster
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  2. Avril Fitzgerald
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  3. Monica Cepoiu
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Investigators of the Western Canada Waiting List Project (WCWL)

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Correspondence to Carolyn De Coster.

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From the Western Canada Waiting List Project and the Centre for Health and Policy Studies, University of Calgary.

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De Coster, C., Fitzgerald, A., Cepoiu, M. et al. Priority-setting tools for rheumatology disease referrals: a review of the literature. Clin Rheumatol 27, 1411–1416 (2008). https://doi.org/10.1007/s10067-008-0938-5

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  • DOI: https://doi.org/10.1007/s10067-008-0938-5

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