Referral criteria from primary care to rheumatology: A qualitative study

To design referral criteria from primary care to rheumatology for patients with rheumatic and musculoskeletal diseases (RMDs).

Qualitative study. A panel of 13 expert rheumatologists and primary care physicians was convened. They defined the inclusion and exclusion criteria for a systematic review to analyse the efficacy and safety of primary care referral protocols/systems/criteria for patients with suspected or diagnosed RMDs. A survey was also launched in primary care setting to assess the level of knowledge of RMDs, available referral systems/criteria and the use of digital health tools for patient referral. The experts discussed the systematic review and survey results and defined and agreed on several referral criteria and other helpful educational materials to be included in a digital application (DerivaREUMA app).

The systematic review identified 32 articles of moderate quality. The survey revealed that more than 60% of primary care physicians lacked standard referral protocols/systems/criteria to rheumatology. A consensus was reached on seven referral criteria, starting with one of the following that have more questions and sub-criteria afterwards: (1) arthritis >3-4 weeks; (2) low-back pain >3 months in patients aged <45 years; (3) systemic autoimmune disease; (4) soft tissue rheumatism; (5) knee and hand osteoarthritis; (6) osteoporosis; (7) complications of rheumatological treatment. The app also contains informative and explanatory material.

We have proposed referral criteria and other helpful materials aimed at promoting and improving efficiency in early referral of patients with RMDs from primary care to rheumatology.