New referrals to rheumatology clinics--why do they keep coming back?

Many rheumatologists are concerned at the number of return visits being made to their out-patient clinics. This study investigates the outcome of 179 general practitioner referrals to two rheumatology clinics during 1987. Forty-one (34%) of the rheumatoid arthritis patients and six (10%) of the osteoarthritis patients made four or more visits. Junior staff discharged far fewer (11-18%) of patients than did consultants (34%). Multiple linear and multiple logistic regression analyses were performed for the demographic and clinical variables which seemed (on univariate analyses) to predict continuing attendance. The maximum disease severity, diagnosis of rheumatoid arthritis, male sex, patient's perceived reason for referral and the hospital clinic only explained 21% of the variation in the number of visits made. Most of the factors influencing hospital clinic doctors are not easily apparent. The data suggested only one method of reducing unnecessary out-patient attendances, namely to increase the number of patients seen by a consultant. Differences in 'clinic policies' and individual doctor's decision-making strategies will require further study.