Towards optimized personalized referral advice and patient satisfaction in chronic musculoskeletal pain

Of all Dutch adults, 1 in 5 has musculoskeletal pain[1]. More than 50% of these people have limited functioning. Experienced disease burden can be reduced by starting an appropriate treatment as early as possible. However, it appears that more than 30% of the patients are referred back to the general practitioner (GP) with a rereferral to somewhere else. This results in an inefficient care path. Therefore, the PReferral project was started in September 2020 and aims to optimize existing care pathways and referrals in healthcare based on artificial intelligence leading to a proof-of-concept decision support system for the GP. In preparation of the PReferral project, an exploration study of individual healthcare pathways, referrals and patient satisfaction was performed in the Netherlands in May 2020. During this study, 84 Dutch people with chronic musculoskeletal pain filled in an online survey. Both qualitative and quantitative methods were used for data analysis. Respondents had an average of 3 different referrals for treatment (SD = 3.2, range 0-17). The GP referred to 34 different regular and alternative care providers in primary, secondary and tertiary care. Referrals were most often made to physiotherapists (n = 55), orthopaedists (n = 37) and neurologists (n = 34). According to the respondents, the choice for referral was usually based on specific complaints (63%), patient's preference (8%) or professional guidelines (13%). Respondents were satisfied with their GP's referral, but rated satisfaction with their entire healthcare pathway low on a 0-10 scale (average = 5.5, SD = 2.0). Communication among care providers was also perceived as very poor on a 0-10 scale (average = 5.2, SD = 2.5). The performed exploration study also showed that healthcare pathways for people with chronic musculoskeletal pain is very diverse. Although this study does not make any statements about the correctness of the referral, the large number of referrals from the GP indicates a suboptimal process. In addition, the low patient satisfaction is a clear signal that current care pathways and referrals should be optimized. [1] Position paper ‘Revalidatie bij chronische pijn aan het houdings- en bewegingsapparaat,’ Conv. Heal. Deal “Chronische Pijn,” 2016.