In the Netherlands, patients with mental health problems often face long waiting times for specialized mental healthcare (SMH) after referral by their general practitioner (GP). During the waiting period, patients may use GP services which can support mental health recovery but also entail risks, such as prolonged medication use. Little is known about the type and amount of care these patients use for their mental health problems in general practice while waiting.We investigated the type and intensity of care utilization in Dutch general practices of patients referred to SMH, to identify areas for improving GP care delivery.We used electronic health records from GPs and claims data from patients referred to SMH (N=27,747) between 2022 and 2023. We analyzed healthcare utilization for mental health problems in terms of GP care, mental health nurse (MHN), or drug prescriptions of these patients within 12 months after referral to SMH. Patient- and practice characteristics were compared between users and non-users of GP services during the waiting period.Preliminary results: Of the referred patients, 61.6% utilized care for mental health problems in general practice while waiting for SMH. Most of the patients utilized care provided by GPs (53.0%) and to a lesser extent by MHN (23.7%). One in eight patients (12.6%) received a new drug prescription during the waiting period, most commonly an anxiolytic (7.5%). Further results will be presented at the conference.More than half of the patients referred to SMH utilize care for mental health problems in general practice, which may reduce the time available for patients with mild psychological problems manageable in primary care. Firstly, reducing waiting times for SMH is key to reduce the burden on GP services. Secondly, providing GPs and MHNs with guidance on supporting patient’s recovery during the waiting period could be important to enhance patient care.Our findings highlight that the burden of care in general practice invoked by patients with a referral to specialized mental health care seems to be considerable.

Low back pain (LBP) is the most common musculoskeletal presentation in primary care, contributing to a significant physical, emotional, and socioeconomic burden. LBP in primary care is estimated to cost the National Health Service (NHS) £5 billion annually. 90-95% of LBP cases are regarded as non-specific, with no underlying spinal pathology. Despite this, lumbar spine radiography is often used in initial assessments. This results in unnecessary radiation exposure, with approximately 65 times the dose used in chest radiography, and avoidable healthcare costs.To review 100 lumbar spine radiography requests from primary care for LBP, assessing compliance with the 2016 NICE guidelines and the 2017 Royal College of Radiologists' referral guidelines, iRefer.This retrospective study included the initial 100 patients who had been referred to an NHS Trust for lumbar spine radiography during May 2024. Data was collected from hospital radiology records. Requests were compared against NICE and iRefer guidelines and analysed accordingly.  59% of X-Ray requests met NICE criteria, whilst 44% met iRefer criteria. The most common clinical indication was for a suspected fracture, accounting for 32% of the X-Ray requests. The most frequent clinical finding was degenerative changes, reported in 68% of lumbar spine X-Rays. Osteoporotic fracture was found in 5% of X-Rays.  Compliance with NICE guidelines was greater than compliance with iRefer, likely due to NICE’s broader recommendations and accessibility, whereas iRefer’s specificity and annual £120 subscription may limit use by GPs. Although MRI remains the preferred imaging modality for disc and soft tissue pathology, long waiting times, patient intolerance, contraindications, and increased costs can result in X-Ray use. The majority of lumbar spine X-Rays demonstrated only degenerative changes, which are better diagnosed clinically. This illustrates how clinical practice must align more closely with NICE and iRefer criteria, to reduce unnecessary radiation exposure and optimise the use of resources. Although lumbar spine X-Ray has a role in diagnosing fractures, a large proportion of X-Ray requests did not meet both NICE and iRefer guidelines, demonstrating the need for improvement. Maximising adherence requires increased access to guidelines, education for both clinicians and patients, and regular audits. 

Severe trauma is a leading cause of death and disability worldwide, requiring rapid and coordinated intervention to optimize survival. Approximately 20% of trauma-related deaths are considered preventable with timely and appropriate management from the first moments after injury.This study aimed to compare epidemiological, clinical, diagnostic, therapeutic, and outcome characteristics of patients presenting by their own means versus those transported via prehospital services, and to assess the impact of prehospital intervention on prognosis.We conducted a retrospective, observational, descriptive, and analytical study in the emergency department from January 1st to December 31st, 2023. The study included patients admitted to the vital emergency room for severe trauma. We analyzed the means of transport to identify particularities of patients benefiting from prehospital medical transport and to evaluate its impact on prognosis.A total of 391 patients were included, with a mean age of 39±17.34 years and a male-to-female ratio of 4.75. Comparing patients transported via prehospital services to those arriving by their own means, significant differences were observed: hemostasis disorders (6.1% vs. 0%), anticoagulant or antiplatelet therapy (10% vs. 7.6%), neurological distress (12.3% vs. 2.4%), cerebral (50.8% vs. 35.4%), pelvic (12.9% vs. 1.2%) and peripheral (19.1% vs. 9.8%) injuries on imaging. Prehospital patients also required more advanced interventions, including vasopressin (11.7% vs. 2.4%), tranexamic acid (21.2% vs. 8.5%), oxygen therapy (66.7% vs. 52.4%), and orotracheal intubation (13.3% vs. 1.2%). Logistic regression identified independent predictive factors for in-hospital mortality: age, heart rate, systolic blood pressure <90 mmHg, peripheral injury, and orotracheal intubation.Prehospital management has been consistently shown to reduce mortality in severe trauma by enabling earlier stabilization and faster access to definitive care, as reported in previous studies (Kim et al., 2025; Murad et al., 2012). Our findings are consistent with this evidence, showing that prehospital-transported patients presented with more severe injuries and required advanced interventions, reflecting effective early triage and initiation of critical care.Prehospital transport improves the vital prognosis of severe trauma patients. Enhanced coordination among emergency services and targeted training for prehospital personnel are essential to further optimize outcomes.

Primary–secondary referral systems aim to coordinate care and steward specialist capacity, yet patients’ lived experiences are often under-captured. We synthesised public narratives about referrals, access and collaboration in primary care across large, open online communities, to identify pragmatic improvements primary-care teams can implement.(1) Characterise how people describe the experience of being referred, referral decision-making, waits and navigation; (2) identify common “workarounds” and perceived drivers; (3) compare patterns across healthcare contexts; (4) surface primary-care actions that could reduce friction.Multi-platform netnography of publicly accessible discussions (2010–2025). Under author instruction and oversight, large language models (LLMs) performed all core steps: locating relevant open forums/social-media communities via neutral search terms; screening threads/posts and curating the corpus (private/paywalled spaces excluded); de-identifying content and paraphrasing quotations; and conducting inductive thematic analysis (LLMs generated codes, consolidated codebooks, clustered themes and drafted analytic memos). No interaction with users occurred; only public data were analysed; no REC/IRB review was sought. To preserve anonymity here, platforms and localities are not named.Across several hundred posts in dozens of threads, five recurrent themes emerged: (1) Gatekeeping & perceived dismissal—reluctance to refer and multiple visits before escalation; a minority defend guideline-concordant GP management. (2) Waits & the “black hole”—limited status feedback and long delays fuel anxiety; knowledge of rights/processes varies. (3) Workarounds & advocacy—self-referrals where allowed, switching clinics/clinicians, private/online routes and, at times, symptom exaggeration. (4) Navigation & communication gaps—unclear responsibility during the wait; some rejections lack actionable feedback. (5) Positive counter-narratives—prompt GP action or effective primary-care management builds trust. Patterns differed by system: tax-funded settings emphasised waits/opacity; insurance-based settings highlighted cost/administrative burden, but core frustrations were shared.Findings echo known access and communication issues while detailing how barriers are experienced. Limitations include self-selection, unverifiable accounts and platform bias. Practical levers include clear, plain-language referral explanations; proactive timeline/status updates with a named contact; contingency plans (“if-not-better-by-X, escalate”); rapid advice-and-guidance; and leveraging continuity to reduce “performing” severity.A multi-platform, anonymised netnography highlights consistent pain points—and low-cost, GP-led remedies—that can reduce avoidable revisits, anxiety and delays in referral pathways.

Neuroleptic Malignant Syndrome (NMS) is a rare but potentially fatal complication of both typical and atypical antipsychotic medications. Its diagnosis remains particularly challenging, as it can easily be mistaken for other medical conditions with similar clinical presentations.We aimed to determine the final rate of confirmed diagnoses among patients referred to the emergency department (ED) for suspected NMS.This was a retrospective, observational, single-center study conducted in the ED of Mahmoud Yaacoub for Urgent Medical Assistance over a five year period from January 2020 to october 2025.We included all patients aged over 18 years who were referred to our ED for suspected NMS. Epidemiological, clinical, and therapeutic data were collected. The presence of diagnostic criteria (clinical and biological) was assessed at two time points, before and after ED referral. The diagnosis of NMS was confirmed or excluded based on well-established diagnostic criteria.A total of 99 patients were evaluated for suspected NMS (mean age 35.4 ± 13.8 years; sex ratio = 6.62). Nearly all patients (99%) were receiving neuroleptic therapy, predominantly for schizophrenia (61.6%). On pre-referral assessment, 86.7% exhibited extrapyramidal signs, 22.4% had altered consciousness, and 40.8% were febrile. Upon ED arrival, these proportions were 45.5%, 15.2%, and 19.2%, respectively. Rhabdomyolysis was identified in 46.4% of cases. Most patients received supportive treatment, primarily intravenous hydration (78.6%); 18.2% required intensive care admission. Ultimately, NMS was confirmed in 22 patients (22.2%). In others, symptoms were attributed to iatrogenic (45.5%), infectious (10.1%), or miscellaneous causes. The median number of diagnostic criteria fulfilled before and after referral was comparable (2 [2–3] vs. 2 [1–3]).Many suspected cases were ultimately unrelated to true NMS, underscoring its frequent mimics. Using standardized criteria is essential for accurate diagnosis and appropriate management.NMS remains a complex diagnostic entity in emergency settings, often mimicked by other conditions. Standardized diagnostic criteria play a critical role in distinguishing true NMS from its clinical imitators, enabling timely and appropriate management.

Referrals from primary to secondary care have risen for years, delaying care, adding cost, and burdening clinicians. Strengthening primary care means keeping appropriate patients in primary care and ensuring that those who need secondary care get there fast. In XXX, a health system serving >300,000 residents, a system-wide, urgency-based four-track pathway was launched to streamline referrals and help GPs refer the right patients: (1) senior-coordinated direct admission for acute cases, (2) on-demand specialist advice, (3) multidisciplinary conferences (MDT) for complex cases, and (4) reverse referral from hospital/EMS to primary care.Estimate the association between pathway launch and referral intensity; assess denial rates and e-consult use; explore heterogeneity across specialties and clinics.Population-level interrupted time-series using the complete referral registry in XXX. Dataset includes every primary-care-initiated referral to secondary care (incl. ED), monthly Jan 2015–Dec 2024: total 1,880,623 (standard 1,738,383; consultation-type 142,240). Activity denominators: all primary-care contacts 14,378,586. Primary outcome: referrals per 1,000 primary-care visits; counts supportive. Segmented ITS with seasonality and a pandemic segment; HAC-robust errors. Pre-specified robustness: alternative anchors and a first-difference model. Subgroup analyses by receiving specialty (incl. ED) and clinic. Quality-improvement evaluation using administrative data; no patient-level identifiers.Preliminary analyses shows a negative post-intervention slope in referrals per 1,000 visits, consistent with progressively fewer referrals over time. Reductions concentrate in medical and surgical specialties; psychiatry appears unchanged to slightly higher. Referrals to ED show no clear change beyond seasonality. Denial rates show no consistent change. E-consults rose around implementation and then stabilised. Effects vary across clinics. Findings are directionally similar under alternative anchors and differencing; interpretation is tempered by pandemic-recovery dynamics and ongoing data cleaning and follow-up.An urgency-based pathway that supports GPs (specialist-on-demand, MDT) can lower low-value referral propensity without changing acceptance thresholds. Variation across clinics and recovery dynamics motivate continued training, simple access to pathway tools and routine activity-adjusted monitoring.At regional scale (>300,000 residents), the four-track pathway is associated with early, system-level signals of reduced referral intensity. Pending full follow-up and planned sensitivity analyses, the model appears feasible and potentially scalable for sustainable primary–secondary collaboration.

The Dutch healthcare system is built on a strong primary care foundation, with general practitioners (GPs) serving as gatekeepers to secondary care. Outside office hours, patients with acute, urgent but non-life-threatening health problems are advised to contact the out-of-hours (OOH) GP services. These services play a key role in maintaining access to emergency care. At the same time, OOH GP services act as a “canary in the coal mine”, with care utilization reflecting how well daytime general practice meets patients’ needs. For instance, when care for older adults (75+) is insufficiently tailored, they are more likely to contact the OOH GP service with acute health problems.To explore two roles of OOH GP care in the Dutch healthcare system: (1) as a gatekeeper preventing unnecessary emergency care, and (2) as an indicator of daytime general practice accessibility and performance.We used routinely collected data from electronic health records of OOH GP services (2019-2025). For objective 1, we analyzed the proportion and characteristics of patients who were referred to the emergency department (ED), ambulance dispatch center, or cardiac emergency unit following an OOH GP contact. For objective 2, we examined trends in OOH GP utilization among adults 75+ and their associated health problems.1) A small proportion (7%) of patients is referred to emergency care. Most patients are referred to the ED (5.3%), after contact with a GP (84.7%), a home visit (11.2%) or a triage consultation (4.1%), and patients are most often referred for abdominal pain (8.8%). 2) Between 2020 and 2024, OOH GP contacts per 1,000 adults aged 75+ declined, mainly due to fewer consultations for specific reasons, including a 50% drop in diabetes-related contacts and a 25% decrease in contacts related to medication side effects.The OOH GP services manage most urgent health problems themselves, potentially preventing unnecessary hospital and ED visits. The decline in contacts among adults aged 75+ seems driven by fewer consultations for conditions such as diabetes, possibly reflecting better daytime management.The findings highlight OOH GP services as both a vital part of the healthcare system and a barometer of daytime GP performance.