{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T03:54:12Z","timestamp":1781582052578,"version":"3.54.5"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":139,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>In the UK, advice and guidance services allow general practitioners (GPs) to seek consultant assistance without formal referral, supporting decision-making and reducing unnecessary secondary care referrals. However, a significant proportion of advice and guidance queries represent frequently asked questions (FAQs), placing avoidable burden on consultants and delaying patient care while replies are awaited. This diagnostic service evaluation aimed to identify common FAQs within rheumatology advice and guidance queries at Morecambe Bay Hospitals Trust (MBHT), with the goal of developing targeted educational material for GPs. This material seeks to improve the quality of advice and guidance referrals to reduce unnecessary secondary care attendances and enhance the delivery of urgent referral pathways in line with targets that are proven to improve patient outcomes. The methodology presented in this article is a reproducible method to bring about iterative improvements to referrals to an individual department through education and behaviour change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective, qualitative content analysis of 2499 GP\u2011initiated rheumatology advice and guidance messages submitted between April 2024 and April 2025. Our analysis occurred in three stages. First, we used NVivo 15 to perform a word\u2011frequency analysis to identify common, clinically significant phrases within advice and guidance queries. Next, for each often\u2011occurring term in our frequency map, we drew a purposive sample of the full advice and guidance conversation in which it appeared. From these, we conducted an in\u2011depth, iterative coding of their content\u2014identifying and refining subthemes\u2014until no new themes were identified. Finally, we filtered the dataset for messages containing \u2018urgent\u2019, \u2018acute\u2019, or \u2018emergency\u2019 to isolate time\u2011sensitive queries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three major themes of FAQs were identified: interpretation of blood tests (especially incongruous blood results and the significance of inflammatory markers), management of osteoporosis (particularly medication queries) and initial treatment or diagnostic uncertainty in suspected giant cell arteritis (GCA). Queries marked as urgent were most commonly associated with GCA. The GPs\u2019 questions were frequently similar within their themes and amenable to concise, standardised advice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Recurring patterns in advice and guidance queries suggest an opportunity to support local GPs through focused educational material; a guidance document targeting the most common FAQs is in development. Although implementation and evaluation are pending, this low-cost, scalable approach may feasibly offer value across specialties and sites. Further study will assess its impact on advice and guidance usage and GP confidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/rap\/rkag054","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T11:45:02Z","timestamp":1778845502000},"source":"Crossref","is-referenced-by-count":0,"title":["Analysis of advice and guidance primary care queries to rheumatology over a calendar year\u2014a diagnostic service evaluation"],"prefix":"10.1093","volume":"10","author":[{"given":"Ethan","family":"O\u2019Shaughnessy","sequence":"first","affiliation":[{"name":"Lancaster Medical School, Lancaster University , Lancaster,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Mulhearn","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary , Lancaster,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4311-5222","authenticated-orcid":false,"given":"Marwan","family":"Bukhari","sequence":"additional","affiliation":[{"name":"Lancaster Medical School, Lancaster University , Lancaster,","place":["UK"]},{"name":"Department of Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary , Lancaster,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"2026061523313399100_rkag054-B1","author":"NHS England"},{"key":"2026061523313399100_rkag054-B2","first-page":"98","article-title":"Integrative review of the last 5 years","volume":"31","author":"Ogrinc","year":"2016","journal-title":"Curr Opin Rheumatol"},{"key":"2026061523313399100_rkag054-B3","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1097\/BOR.0000000000000586","article-title":"Quality improvement initiatives in rheumatology: an integrative review of the last 5 years","volume":"31","author":"Liu","year":"2019","journal-title":"Curr Opin Rheumatol"},{"key":"2026061523313399100_rkag054-B4","volume-title":"NVivo (version 15) [computer software]","author":"QSR International","year":"2023"},{"key":"2026061523313399100_rkag054-B5","author":"Medical Research Council"}],"container-title":["Rheumatology Advances in Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/rheumap\/advance-article-pdf\/doi\/10.1093\/rap\/rkag054\/68345936\/rkag054.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/rheumap\/article-pdf\/10\/3\/rkag054\/68345936\/rkag054.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/rheumap\/article-pdf\/10\/3\/rkag054\/68345936\/rkag054.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T03:31:47Z","timestamp":1781580707000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/rheumap\/article\/doi\/10.1093\/rap\/rkag054\/8688188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":5,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6,15]]}},"URL":"https:\/\/doi.org\/10.1093\/rap\/rkag054","relation":{},"ISSN":["2514-1775"],"issn-type":[{"value":"2514-1775","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026]]},"published":{"date-parts":[[2026]]},"article-number":"rkag054"}}