OBJECTIVES: Integrated Health Organisations (IHO) match reference hospitals and primary care (PC) in the Basque Public Health System since 2012. Integrated care refers mainly to the new approach of care delivery for patients with chronic diseases; however, it might be also beneficial to empower PC with the objective of reducing unnecessary resource consumption in specialized consultations related to muscle-skeletal diseases.

METHODS: This was a retrospective observational comparative effectiveness study carried out in the IHO Goierri-Alto Urola, Gipuzkoa, Spain. All the patients with an incident muscle-skeletal episode in PC in 2012 and 2016 were included in the study. The intervention was implemented from 2013 onwards and consisted on a specific clinical pathway for knee and shoulder related diagnosis as well as for osteoporosis and low back pain. At the same time PC was enabled for direct access to magnetic resonance image and bone densitometry. Electronic health records were used in order to obtain resource consumption data for the patients included in the study. Genetic matching algorithm was applied in order to avoid selection bias.

RESULTS: CONCLUSIONS: The implemented integrated model achieved the expected derivation rate reduction together with a shift to move derivations to services other than Traumatology. It was noteworthy, in terms of clinical management, that the value of the decrease in overall derivations was 11%. Therefore, PC empowerment related to muscle-skeletal diseases permitted lowering the bottleneck to Traumatology service consultations and improved efficiency.