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Implementation of a shared care guideline for back pain: effect on unnecessary referrals
Margot Fleuren1, Elise Dusseldorp, Susan van den Bergh
1Prevention and Health Department, TNO Quality of Life, PO Box 2215, 2301 CE Leiden, The Netherlands. margot.fleuren@tno.nl
Objective:
To determine the effect of the implementation of a shared care guideline for the lumbosacral radicular syndrome (LRS) on unnecessary early referrals and the duration of the total diagnostic procedure.
Design:
Introduction of shared care guideline in November 2005. Pre-test in 2005 (April to October), a first post-test in 2006 (April to October) and a second post-test in 2007 (April to October).
Setting:
and
Intervention:
The introduction of a shared care guideline derived from national guidelines for GPs and several medical/paramedical specialists in two Dutch regions. Three hundred and sixty GPs, 550 physiotherapists and two hospitals (9 neurologists and 18 radiologists) were involved. The essential component of the guideline was a trade-off: if the GP complied with the conservative management approach in the first 6 weeks, the hospital guaranteed a priority appointment with the neurologist after 6 weeks, if still required.
Main Outcome Measures:
The neurologists in both hospitals registered whether a patient had been unnecessarily referred during the first 6 weeks. The duration of the total diagnostic procedure was defined as the number of days between referral by the GP and the consultation when the neurologist made the final diagnosis.
Results:
The percentage of patients being unnecessarily referred within 6 weeks fell significantly from 15% in 2005 to 9% in 2006 and 8% in 2007. The duration of the total diagnostic procedure also fell significantly in both the long and short terms.
Conclusions:
The introduction of a shared care guideline for all care providers in a region reduces the number of unnecessary early referrals for patients with LRS.
