Outcomes of rheumatology referrals seen in a general medicine clinic

Rheumatology outpatient clinics are facing increasing referral volumes, including new and long-term patients. International studies suggest that initial assessments by non-rheumatologists can be effective.

This study evaluates the role of a general medicine clinic in managing patients initially referred to rheumatology at an Australian tertiary hospital.

We retrospectively reviewed rheumatology referrals diverted to the general medicine clinic at The Northern Hospital, Victoria, from 1 January 2023 to 30 June 2024. Data included patient demographics, referral reasons, investigations and clinical outcomes. Multiple indications were recorded where applicable. Ethics approval was obtained.

Fifty-three referrals were redirected to general medicine. Common referral reasons included arthritis (41.5%) and abnormal pathology (17%). Rheumatology-specific histories were documented in 86.3% of patients, with 34.1% showing positive findings. Rheumatological exams were performed in 60%, with positive findings in 19.2%. Two patients did not attend appointments. Following review, 60.8% underwent repeat pathology and 45.1% had radiology. Ten (19.6%) patients were initiated on treatment in general medicine. Nine (17%) were referred to rheumatology, with seven receiving a rheumatological diagnosis. The most common diagnoses made in general medicine were benign conditions such as musculoskeletal injuries (34%) and fibromyalgia (20.8%).

General medicine clinics may effectively triage and manage patients initially referred to rheumatology, potentially reducing unnecessary specialist consultations. In our cohort, only 17% required rheumatology referral, supporting the role of general medicine in preliminary rheumatologic evaluation within the Australian healthcare context.