Should rheumatologists provide an acute referral service for general practitioners (GPs) and other clinical units ?
Is it cost effective ?
We prospectively studied acute referrals to one unit over 10 months, recording their source, diagnosis, management and outcome.
Current rheumatology patients and cases only needing telephone advice were excluded.
There were 253 referrals : 82 from GPs, nine from Accident and Emergency, and 162 from other hospital units.
Their diagnoses comprised connective tissue diseases (22), back pain (46), inflammatory arthritis (59), osteoarthritis (22), paediatric cases (11), soft tissue problems (41) and 52 other disorders.
Thirty-two needed active treatment within 24 h (classified as emergencies) ; examples included cerebral lupus, vasculitic pulmonary haemorrhage, retroperitoneal lymphoma with sacral plexus compression, temporal arteritis with reduced visual acuity and acute monoarthritis.
All needed immediate therapy ; only one died.
Most (176 cases) were less urgent and needed advice in 48 h. Examples included osteoporotic vertebral collapse and acute rheumatoid disease.
Forty-five could have been seen routinely ; examples included lateral epicondylitis and adhesive capsulitis.
The service required 1 day per week of medical staff time at an average cost of £45 per case.
We concluded that an acute rheumatology service is needed ; it can be provided within the working day and is cost effective.
Mots-clés Pascal : Royaume Uni, Rhumatologie, Système ostéoarticulaire pathologie, Homme, Service santé, Milieu hospitalier, Urgence, Consultation, Europe
Mots-clés Pascal anglais : United Kingdom, Rheumatology, Diseases of the osteoarticular system, Human, Health service, Hospital environment, Emergency, Consultation, Europe
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0234902
Code Inist : 002B30A01C. Création : 199608.