An evaluated programme of rheumatology training for general practitioners.

The management of painful, upper-limb disorders by 34 general practitioners (GPs) was examined 3 months before and 3 months after personal instruction of GPs by a consultant rheumatologist. Tuition was conducted either in GP surgeries or a hospital out-patient department. Following instruction there were significant increases in the application of appropriate treatments (p less than 0.0005) and of local corticosteroid injections by GPs (p less than 0.005), fewer requests for investigations and less-frequent hospital referrals for consultant rheumatology opinions. Hospital out-patient instruction was associated with a significant reduction of patients' time off work (p less than 0.005) and, in general, differences of management appeared to be more pronounced amongst those GPs instructed in the hospital than in GP surgeries. The study showed that personal instruction of GPs by a consultant rheumatologist may result in modifications of practice, at least in the short term. The evidence indicates that such alterations of GP management may significantly reduce patient morbidity.