Impact of an interdisciplinary digital consultation platform on general practitioner referrals for musculoskeletal symptoms: A stepped wedge cluster randomized trial

Abstract

The aim of the study was to assess the effect of an interdisciplinary, digital consultation platform on the proportion of appropriate referrals from general practitioners (GPs) to an orthopaedic outpatient hospital.We performed a stepped wedge, cluster, randomized controlled trial. Sixty GP practices in the catchment area of a large teaching hospital in the Netherlands were randomized. Groups of GP practices entered the trial in four steps at 13-week intervals, at which point they received access to the Prisma platform. The platform allowed them to post questions about anonymized cases to a multidisciplinary group of specialists. During the control condition, GPs did not receive platform access. In both conditions, GPs provided care as usual. The proportion of appropriate referrals, defined as referrals for which a patient had either (i) more than one consultation with an orthopaedic surgeon or (ii) one consultation with additional diagnostics or interventions, was the primary outcome.Participating GPs referred 4928 patients to hospital. Intention-to-treat analysis showed a 4.4% estimated increase in the proportion of appropriate referrals among GP practices randomized to have access to the platform compared to the control group, with an odds ratio (OR) of 1.22 [95% confidence interval (CI), 1.01-1.46; P = 0.037]. Per-protocol analysis showed a smaller, but non-significant, 2.2% difference between interventions, with an OR of 1.11 (95% CI, of 0.96%-1.28%; P = 0.178).We observed a modest increase in appropriate referrals for orthopaedic review among GP practices randomized to the platform. On a larger scale, this could contribute to more sustainable access to specialist care.This study looked at whether a digital consultation platform could help general practitioners (GPs) make better decisions when referring patients to orthopaedic specialists. The platform, called Prisma, allowed GPs to ask questions about anonymized patient cases and receive advice from a team of medical specialists before deciding whether to refer the patient to a hospital. To test the platform's effect, researchers conducted a trial with 60 GP practices in the Netherlands. The key measure was whether referrals were "appropriate," meaning that the hospital visit led to more than one consultation or additional tests or treatments. In total, 4928 patients were referred. We found that GPs given access to the platform made 4.4% more appropriate referrals than those who did not. However, when analysing only those GPs who actively used the platform as intended, the improvement was smaller (2.2%). Overall, the results suggest that using a digital consultation tool may improve the quality of referrals to orthopaedic specialists. If adopted more widely, this approach could help ensure better use of hospital resources and improve patient care.