Mobiele menu

Impact of a consultation platform for GPs andspecialists on referrals to secondary care

Projectomschrijving

Impact van een netwerkgeneeskundig platform op verwijzingen naar de tweede lijn

Het aantal verwijzingen naar ziekenhuizen neemt toe. Dat kost patiënten moeite en geld terwijl zij daar vaak een behandeling krijgen die de huisarts ook had kunnen geven.

Doel

Onnodige verwijzingen leiden tot langere wachttijden en hogere zorgkosten. Als huisartsen makkelijker vragen kunnen stellen aan collega’s in de tweede lijn, kunnen zij meer zorg in de eigen praktijk leveren. Prisma is een zogeheten netwerkgeneeskundig platform. Op dit besloten platform stellen huisartsen vragen over anonieme casussen en geven specialisten antwoord. Wij onderzoeken de invloed van Prisma op verwijzingen naar het Isala beweegcentrum.

Werkwijze

Stapsgewijs krijgen alle huisartsen in de regio Zwolle toegang tot Prisma. We vergelijken het aantal verwijzingen van Prisma-gebruikers met huisartsen die het platform (nog) niet gebruiken. Ook vergelijken we de behandelingen in de huisartsenpraktijk tussen deze groepen. Ten slotte onderzoeken we de verwachtingen en ervaringen van patiënten en deelnemende artsen.

Producten

Titel: Impact of digital interdisciplinary consultation on secondary care referrals by general practitioners: a protocol for a stepped-wedge cluster randomised controlled trial
Auteur: Sanavro S, van der Worp H, Jansen D, Stoffelen J, Schers H, Postma M, Koning P, de Boer M, Janus G, Blanker MH
Magazine: BMJ Open

Verslagen


Samenvatting van de aanvraag

Background In the Dutch health care system, general practitioners (GPs) have a gatekeeper function. Despite the thorough guidelines commissioned by the Dutch GP Society (NHG), a considerable number of patients are referred to secondary care, where they receive no other care than a conservative treatment. For example, about 70% of patients referred to the orthopaedic outpatient department received no treatments that a GP could not have offered. These ‘unnecessary’ referrals could be avoided it GPs were able to easily consult medical specialists before referral. The mutual unavailability impedes such interdisciplinary consultations. Reduction of unnecessary referrals is important as it brings burden and costs to patients, increases the workload in secondary care, extents waiting lists, but also increases societal costs. The network medicine platform Prisma could offer a solution for this, by offering asynchronous, accessible and fast teleconsultation between GPs and specialists, within a secured app (Siilo). In fact, in a recent pilot study in the Nijmegen-region, we showed that the number of referrals decreased considerably, when GPs applied such consultation before referral. The size of that study, and the absence of a control group, however, impair drawing firm conclusions on the actual impact of the use of the Prisma platform. Purpose We aim to study the impact of the use of the Prisma platform on the number of referrals to the Isala Movement Centre. Methods Together with the patient organisation ZorgbelangInclusief, the Isala Movement Centre, and Prisma, our academic departments will conduct a stepped-wedge cluster randomised controlled trial in the catchment area of Isala. In this region, Isala is the only hospital providing both diagnostic utilities for the GPs, and secondary care. Only a negligible number of GPs in this area already have access to the intervention. General practices in the area will be randomised to the intervention in four steps, of three months each, resulting in all practices being allocated to the intervention after one year. Randomisation will be stratified according to group size (number of GPs in a practice) and current referral patterns. GPs will get instant access to the Prisma platform and will be able to post cases. Specialists (orthopaedics, sports medicine physicians, and rheumatologists) will answer questions. Other GPs are able to read (and learn from) casuistry, and may also respond to such cases. The intervention is not available for the control group. Main outcome will be the number of referrals to the Isala Movement Center, collected from the hospital registry. With 46 general practices and 155 GPs, the study region is large enough to detect a 16% decrease of unnecessary referrals (even allowing non-participation by GPs). Secondary outcomes will be user satisfaction, and cost-effectiveness that will be based on hospital registry (both referrals and additional diagnostics performed), supplemented by routine care data from the GPs. For the latter, the method of data collection and data handling of the Academic GP Network (AHON) of UMCG will be used, requiring no efforts from the participating GPs. Next, we will inventory barriers and facilitators for the use of the Prisma platform, using questionnaires completed by GPs, and discussion with GP trainees in the region. ZorgbelangInclusief will inventory the opinions of patients with regard this type of consultation. This study will answer four prioritized questions from the Dutch GP research agenda. If proven (cost) effective, the Prisma platform may serve all Dutch GPs, covering other disciplines as well. This project will seek answer if the Prisma motto “Move knowledge, not patients” holds true.

Kenmerken

Projectnummer:
10060011910001
Looptijd: 100%
Looptijd: 100 %
2021
2024
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
dr. H. van der Worp
Verantwoordelijke organisatie:
Universitair Medisch Centrum Groningen
Afbeelding

Enkelvoudige onderzoeksvragen uit de huisartsenpraktijk

Om in betrekkelijk korte tijd een antwoord te geven op kennisvragen uit de prioriteiten van de Nationale Onderzoeksagenda Huisarts-geneeskunde, financieren we 7 projecten die aan de slag gaan met enkelvoudige onderzoeksvragen. Dit project is daar één van. Bekijk de andere projecten.