• Tessa C C Quanjel, Anne Winkens, Marieke D Spreeuwenberg, Jeroen N Struijs, WinkensRon A GRAGf Diagnostic Centre , Maastricht University Medical Centre (Maastricht UMC+) , Maastricht , The Netherlands., Caroline A Baan, and Dirk Ruwaard.
• a Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands.
• Scand J Prim Health Care. 2018 Mar 1; 36 (1): 9910699-106.

ObjectiveConsistent evidence on the effects of specialist services in the primary care setting is lacking. Therefore, this study evaluated the effects of an in-house internist at a GP practice on the number of referrals to specialist care in the hospital setting. Additionally, the involved GPs and internist were asked to share their experiences with the intervention.DesignA retrospective interrupted times series study.SettingTwo multidisciplinary general practitioner (GP) practices.InterventionAn internist provided in-house patient consultations in two GP practices and participated in the multidisciplinary meetings.SubjectsThe referral data extracted from the electronic medical record system of the GP practices, including all referral letters from the GPs to specialist care in the hospital setting.Main Outcome MeasuresThe number of referrals to internal medicine in the hospital setting. This study used an autoregressive integrated moving average model to estimate the effect of the intervention taking account of a time trend and autocorrelation among the observations, comparing the pre-intervention period with the intervention period.ResultsIt was found that the referrals to internal medicine did not statistically significant decrease during the intervention period.ConclusionsThis small explorative study did not find any clues to support that an in-house internist at a primary care setting results in a decrease of referrals to internal medicine in the hospital setting. Key Points An in-house internist at a primary care setting did not result in a significant decrease of referrals to specialist care in the hospital setting. The GPs and internist experience a learning-effect, i.e. an increase of knowledge about internal medicine issues.

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