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Development of Hip/Knee Pathway between Primary and Secondary Care

Authors: Aisling Brennan , Caitriona Ni She, Sarah O Driscoll, Elaine Barker, Conor McNally, Joe Malone

Abstract Introduction: Hip and Knee referrals are the most common General Practioner (GP) referral to the Musculoskeletal (MSK) Triage service in Tallaght hospital. Between 2012-2014, 74% of patients with hip and knee pathology were discharged at their MSK Triage clinic visit and 59% were referred to physiotherapy. Therefore, the need for these patients to be referred to secondary care is questionable. Physiotherapy is recommended for non-traumatic hip and knee pathology prior to considering invasive intervention1,2. The objective was toestablish a care pathway for patients with non-traumatic hip and knee conditions between primary and secondary care. The aims of this pathway was to: 1) Provide timely access to physiotherapy for patients; 2) Improve access for patients requiring further investigations or specialist opinion; 3) Improve communication and streamline care between primary and secondary care services.All patientsresiding in Dublin South West (DSW) are eligible for referral to this pathway. GPs in DSW were encouraged to refer patients with any non-traumatic hip or knee pathology to PCCC physiotherapy in the first instance, who will then refer onto MSK Triage Clinics where appropriate. Any patients who the PCCC physiotherapist deems appropriate for onward referral will be seen at the MSK Triage Clinic within one month of referral.Methods: In November 2015 a care pathway for patients presenting to GPs with non-traumatic hip or knee pain was established between the MSK Triage Service in Tallaght Hospital, GPs and DSW physiotherapy department.The total number of hip and knee referrals received to the MSK Triage service were compared between January-June 2015 and 2016. As the pathway was in DSW, the number of referrals from DSW GPs only was compared between May-July 2015 and 2016. The number of DSW physiotherapy referrals from GPs was also reviewed.Results: The number of referrals from all GPs to the MSK Triage Service for January-June 2015: Hip: 86; Knee: 253 compared to January-June 2016: Hip: 106; Knee: 244. The percentage of referrals to the MSK Triage Service from DSW GPs reduced from May-July 2015 (41% of total referrals) compared with May-July 2016 (34% of total referrals). The percentage of hip and knee referrals from DSW GPs to DSW increased from 33% of total referrals to 63% of total referrals.Discussions/Conclusions: This initial data shows promising results that GPs in DSW are increasing their utilisation of physiotherapy services in primary care. Results demonstrate that there is the need for further promotion and dissemination of the pathway with GPs in DSW and although there is an increased referral to physiotherapy, they need to be encouraged not to send a duplicate referral to secondary care. Results demonstrate that the number of referrals to the MSK Triage service has not changed in the first six months following the introduction of the pathway. However, these figures include referrals from all GPs rather than just DSW. Future developments include introducing this pathway to other primary care areas.


hip pathway, knee pathway, msk triage, primary care physiotherapy

How to Cite:

Brennan A, Ni She C, O Driscoll S, Barker E, McNally C, Malone J. Development of Hip/Knee Pathway between Primary and Secondary Care. International Journal of Integrated Care. 2017;17(5):A339.

DOI: on 17th October 2017