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Implementation of a shared care guideline for back pain: Effect on unnecessary referrals

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Author: Fleuren, M. · Dusseldorp, E. · Bergh, S. van den · Vlek, H. · Wildschut, J. · Akker, E. van den · Wijkel, D.
Institution: TNO Kwaliteit van Leven
Source:International Journal for Quality in Health Care, 5, 22, 415-420
Identifier: 409822
Article number: No.: mzq046
Keywords: Health · Leefomgeving en gezondheid · Guideline adherence · Hospitals · Implementation · Primary health care · Quality of health care · Sciatica · article · backache · conservative treatment · diagnostic procedure · general practitioner · health care cost · health care planning · health care quality · health service · lumbosacral radicular syndrome · medical specialist · nerve root compression · paramedical personnel · patient referral · physiotherapist · practice guideline · priority journal · radiologist · shared care guideline


Objective: To determine the effect of the implementation of a shared care guideline for the lumbosacral radicular syndrome (LRS) on unnecessary early referrals and the duration of the total diagnostic procedure. Design: Introduction of shared care guideline in November 2005. Pre-test in 2005 (April to October), a first post-test in 2006 (April to October) and a second post-test in 2007 (April to October). Setting and Intervention: The introduction of a shared care guideline derived from national guidelines for GPs and several medical/paramedical specialists in two Dutch regions. Three hundred and sixty GPs, 550 physiotherapists and two hospitals (9 neurologists and 18 radiologists) were involved. The essential component of the guideline was a trade-off: if the GP complied with the conservative management approach in the first 6 weeks, the hospital guaranteed a priority appointment with the neurologist after 6 weeks, if still required. Main Outcome Measures: The neurologists in both hospitals registered whether a patient had been unnecessarily referred during the first 6 weeks. The duration of the total diagnostic procedure was defined as the number of days between referral by the GP and the consultation when the neurologist made the final diagnosis. Results: The percentage of patients being unnecessarily referred within 6 weeks fell significantly from 15% in 2005 to 9% in 2006 and 8% in 2007. The duration of the total diagnostic procedure also fell significantly in both the long and short terms. Conclusions: The introduction of a shared care guideline for all care providers in a region reduces the number of unnecessary early referrals for patients with LRS. © The Author 2010. Published by Oxford University Press in association with the International Society for Quality in Health Care.