title: Joint consultation of general practitioner and rheumatologist: does it matter?
abstract: OBJECTIVE
  To assess the effects of joint consultation on referral behaviour of general practitioners (GPs) in a prospective cohort study.
  
  
  METHODS
  All patients with rheumatological complaints that 17 participating GPs, from the area of the University Hospital Maastricht, wanted to refer during a two year inclusion period (n=166) were eligible for inclusion. These patients were either referred to the outpatient clinic, or presented at a joint consultation held every six weeks at the practice of the GP, where groups of three GPs presented their patients to a visiting, consulting rheumatologist. The number of patients referred by each GP a year at the end of the trial, comparing participating and non-participating GPs, was the main outcome measure.
  
  
  RESULTS
  During two years of inclusion, the 17 participating GPs presented 166 patients. The number of patients referred by each GP a year decreased for the participating GPs by 62% at the end of the whole study. By contrast, non-participating GPs maintained the same rate of referral. The range of diagnoses remained proportionally the same throughout the study, with the exception of fibromyalgia. The referral rate of this diagnosis decreased significantly (p=0.001).
  
  
  CONCLUSIONS
  Joint consultation seems to be a good strategy in influencing the referral behaviour of GPs in the area of rheumatology. The decrease in referral is substantial and can subsequently lead to a reduction of waiting lists.
authors.affiliation: Department of Transmural Care, University Hospital Maastricht, Maastricht, The Netherlands. gusc@bze7.azm.nl
authors.forename: G J C
authors.initials: GJ
authors.lastname: Schulpen
authors.forename: W P M
authors.initials: WP
authors.lastname: Vierhout
authors.forename: D M
authors.initials: DM
authors.lastname: van der Heijde
authors.forename: R B
authors.initials: RB
authors.lastname: Landewé
authors.forename: R A G
authors.initials: RA
authors.lastname: Winkens
authors.forename: S
authors.initials: S
authors.lastname: van der Linden
mesh_terms: D000328:Adult; D005194:Family Practice / Q000592:standards*; D005260:Female; D018578:Hospital-Physician Relations; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D012216:Rheumatic Diseases / Q000175:diagnosis*; D012219:Rheumatology / Q000592:standards*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data