Impact of a digital interdisciplinary consultation platform for GPs and specialists on referrals to secondary care in the Netherlands.

General Practitioners (GPs) play a crucial role in the Dutch healthcare system. They have a gatekeeper function for the patient- access to specialists if needed. Despite the guidelines that GPs use in their daily practice (NHG) and the (time-challenging) telephonic advices given by specialists, a number of patients is still unnecessarily referred to the hospital or referred to the wrong department. After visiting a specialist, a group of patients only receive a conservative treatment which could also have been given by the GP. In the current situation, there is a lack of (time) convenient communication and discussion between GPs and specialists on daily patient care. This results in inadequate referrals for patients and as a result the time, costs and waiting lists growing.
The PRISMA digital interdisciplinary consultation platform, is designed to fill in that gap. It offers an asynchronous consultation for GPs to specialists, not limited to one-on-one communication, as this group of GPs can read and learn from each-others casus. A single centre pilot on PRISMA in Nijmegen-region has proven a considerable decrease in referrals to specialist, but it was a small group and lacked a controle group.
Our randomized controlled trial has a stepped-wedge design where over 1 year time, GPs in Zwolle-region will receive access to the PRISMA platform. will be compared to the standard care. Number of (inadequate) referrals to Isala Movement Center will be evaluated based on hospital registry. Next, user satisfaction, cost-effectiveness will be analyzed based on hospital registry plus routine care data from GPs on basis of data of the Academic GP Network (AHON). Last, inventory barriers and facilitators for use of PRISMA will be evaluated by use of questionnaires filled out by GPs, specialists as well as a qualitative analysis using interviews and focus groups to evaluate patient opinions and experiences.

With use of this platform by GPs in Zwolle-region, the number of unnecessary referrals to Isala Movement Centre will decrease.

During the first year, every 12 weeks a new group of GPs will have access to Prisma for their digital consultations. In a stepped wedge design, 4 groups will start. Data on DBCs, referrals, app use, patient en user experience will be analysed between users and non-users of Prisma in a period of 2 years time.

a Stepped wedge access of GPs to the use of the PRISMA platform