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

Background 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. Methods 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. Results 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). Conclusions 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.