Alternative Referrals for ACC Injuries

Annually in Dunedin ACC covers care for about 1500 patients with musculoskeletal injuries. These patients are currently referred to the orthopaedic surgeon for assessment, investigation, and/or surgical treatment. About 33% ultimately have orthopaedic surgery. The remaining 67% receive care that could be delivered by GPs with access to appropriate resources (e.g. MRI and CT scans) and training in advanced primary care procedures (e.g. joint injection). Waiting times from referral by their GP to first assessment by orthopaedic surgeons currently average 13 weeks. Earlier assessment and/or intervention by a GP with a special interest in orthopaedics (GPSI) may reduce the time patients wait until they have definitive treatment and thereby reduce their time to functional recovery. Alternatively, GPSI care may simply delay needed orthopaedic surgical intervention. The GPSI programme is new to New Zealand. We propose to study its introduction in Dunedin. The study will not alter the processes already established to manage appropriate care for patients with orthopaedic injuries EXCEPT by randomising the first 110 eligible patients to Usual Care or GPSI care. Most study data will come from data routinely collected on ACC forms and in patient records.