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Post Reproductive Health Mar 2021Requests for management of menopausal symptoms and hormone replacement are increasing in the UK. Referrals to specialist clinics have to be balanced with increasing...
OBJECTIVE
Requests for management of menopausal symptoms and hormone replacement are increasing in the UK. Referrals to specialist clinics have to be balanced with increasing recommendations within the NHS to improve efficiency and patient care.
STUDY DESIGN
Retrospective evaluation of clinic records over two months at a district general (Poole Hospital) and tertiary (Guy's Hospital) menopause service. Data on referral origin, reason for referral, interval from referral to review and outcome were collected and compared between trusts.
MAIN OUTCOME MEASURES
To evaluate and compare referrals and outcomes in a tertiary and district general menopause service and provide recommendations for improving efficiency.
RESULTS
Most referrals are from primary care but up to 25% are from other specialties. Half of the appointments are new referrals and 95% of women attend. Of the new referrals, 50% have multiple medical comorbidities, 25% a personal or family history of cancer and 25% treatment resistance; 30% have premature ovarian insufficiency. At Guy's Hospital, 30% are reviewed more than 18 weeks after referral, at Poole Hospital this is 6%. Treatment resistance is reported in half of the women reviewed at follow-up.
CONCLUSIONS
Menopause services review a complex patient population and the majority of referred women have more than one co-morbidity; they require time, specialist knowledge of current treatment options and a multidisciplinary approach. The main barrier to service efficiency is capacity, particularly in population dense areas; cognitive behavioural therapy and non-hormonal methods appear under-utilised in primary care, as do alternative methods of follow-up within the clinics such as telephone and patient-initiated appointments.
Topics: Female; Hormone Replacement Therapy; Hospitals, General; Humans; Menopause; Referral and Consultation; Retrospective Studies
PubMed: 32854595
DOI: 10.1177/2053369120947620 -
Journal of Clinical Nursing Sep 2020To (a) characterise and determine proportions of referred and enrolled children and (b) explore public health nurses' (PHNs) experiences, perspectives and...
AIMS AND OBJECTIVES
To (a) characterise and determine proportions of referred and enrolled children and (b) explore public health nurses' (PHNs) experiences, perspectives and recommendations regarding a new nurse-led referral pathway for paediatric weight management.
BACKGROUND
Children with obesity and their families in Canada access specialised services for obesity management through physician referral. Since this requirement can prevent timely access to health services, we established and tested a referral pathway whereby PHNs directly refer children to specialised care for obesity management.
DESIGN
Nested mixed-methods study reported using GRAMMS.
METHOD
Our research study included children (2-17 years of age; body mass index ≥85th percentile) referred by a PHN to the Pediatric Centre for Weight and Health (PCWH; Stollery Children's Hospital, Edmonton, Alberta, Canada) from April 2017-September 2018. We summarised referral and enrolment data using descriptive statistics and conducted one-on-one, semi-structured telephone interviews with PHNs; interviews were audio-recorded, transcribed verbatim, managed using NVivo 12 and analysed by two independent reviewers using content analysis.
RESULTS
Our sample included 79 referred children (4.4 ± 1.8 years old; 3.4 ± 1.3 BMI z-score; 52.7% male), of which 47 (59.5%) enrolled in care. PHNs' (n = 11) experiences, perspectives and recommendations regarding the new referral pathway were grouped into four categories: (a) practicality of the referral pathway (e.g., simple and straightforward), (b) utility of the referral pathway (e.g., economic and timesaving), (c) uptake of the referral pathway (e.g., physician's influence) and (d) recommendations to improve the referral pathway (e.g., having electronic access to the referral form).
CONCLUSIONS
A PHN-specific referral pathway led most children and families to enrol in paediatric weight management and overall was perceived as acceptable and appropriate among PHNs.
RELEVANCE TO CLINICAL PRACTICE
Our results highlight the valuable role that PHNs can play in directly referring children to specialised services for weight management. This pathway has the potential to reduce wait times and enhance treatment enrolment.
Topics: Adolescent; Alberta; Child; Child, Preschool; Female; Humans; Male; Nurses, Public Health; Pediatric Obesity; Referral and Consultation
PubMed: 32473035
DOI: 10.1111/jocn.15350 -
Rehabilitation Nursing : the Official... 2020This study investigated the dynamics of patient-provider communication in the cardiac rehabilitation (CR) referral process, to identify which aspects lead to CR...
This study investigated the dynamics of patient-provider communication in the cardiac rehabilitation (CR) referral process, to identify which aspects lead to CR participation. Semi-structured individual interviews were conducted with 31 patients eligible for CR. Questions probed the content and perception of the discussion that patients had with healthcare providers (HCP) regarding CR attendance. The interviews were audiotaped, transcribed, and imported into N6 software for grounded analyses. Key emerging themes were identified: illness perceptions; HCP encouragement; timing of discussion; and ease of referral. CR attenders were apt to self-advocate to ensure their enrollment in CR, whereas nonattenders were more likely to minimize the seriousness of their disease, and less likely to persevere to overcome obstacles in enrolling in a CR program. Surprisingly, the strength of the HCP referral did not influence the decision to attend CR as strongly when compared to the HCP's ability to facilitate enrollment in a CR program.
Topics: Aged; Cardiac Rehabilitation; Communication; Female; Humans; Interviews as Topic; Male; Middle Aged; Professional-Patient Relations; Qualitative Research; Referral and Consultation; Statistics, Nonparametric
PubMed: 32858709
DOI: 10.1097/rnj.0000000000000279 -
The Nigerian Postgraduate Medical... 2023An effective referral system is crucial for a high-quality health system that provides safe medical care.
INTRODUCTION
An effective referral system is crucial for a high-quality health system that provides safe medical care.
AIM AND OBJECTIVES
This study aimed at evaluating the appropriateness and adequacies of information in the referral letters of patients.
MATERIALS AND METHODS
A prospective study of referral letters of all new patients in the urology clinic. Information retrieved was socio-demographic characteristics, source of referral and presence or absence of important information in their letters. We compared the information provided to the new history taken to determine the appropriateness and adequacy using different domains of medical history. Referrals were adjudged appropriate if the diagnosis is urologic, while any referral lacking relevant information is adjudged inadequate. The results were displayed using the simple proportions in tables and charts.
RESULTS
A total of 1188 referrals were reviewed. There were 997 (83.9%) males and 191 (16.1%) females. Referrals from private hospitals were the most common in 627 (52.8%) cases. Of all new referrals, 1165 (98.1%) were adjudged to be appropriate, while 23 (1.9%) were inappropriately referred. Referrals from teaching hospitals had higher proportions of good-quality referrals than those from primary healthcare and private centres. The most common deficiencies were the lack of documentation of relevant examination findings (37.8%) and provisional diagnosis (21.4%). The majority, 956 (80.5%), of letters were narrative in nature, whereas 232 (19.5%) were structured. Structured letters were found to be more informative.
CONCLUSION
A significant percentage of referral letters lacked completeness in many key areas. We recommend the use of structured forms or template letters to improve the quality of referrals.
Topics: Male; Female; Humans; Prospective Studies; Nigeria; Hospitals, Teaching; Referral and Consultation; Ambulatory Care Facilities
PubMed: 37148119
DOI: 10.4103/npmj.npmj_16_23 -
Canadian Family Physician Medecin de... Jul 2023To further understand and optimize primary care provider (PCP) referrals to a 1-time psychiatric consultation service by developing profiles of PCP referrers, assessing...
OBJECTIVE
To further understand and optimize primary care provider (PCP) referrals to a 1-time psychiatric consultation service by developing profiles of PCP referrers, assessing PCP satisfaction with the service, and determining intervention opportunities.
DESIGN
Secondary analysis of a referral database and subsequent cross-sectional survey of referrers.
SETTING
Winnipeg, Man.
PARTICIPANTS
All family physicians who had made at least 1 referral in 2017 to the Centralized Psychiatric Consultation Service for Adults, a 1-time consultation service.
MAIN OUTCOME MEASURES
Referral frequency, individual and practice characteristics, satisfaction with the Centralized Psychiatric Consultation Service for Adults, and subjective drivers of referral activity were assessed. Interest in a range of intervention opportunities to increase mental health knowledge and support were also examined.
RESULTS
Of the 403 family physicians who referred patients to the consultation service in 2017, a total of 111 (27.5%) responded to the survey. Among all referrers, 287 (71.2%) were low referrers (1 to 4 referrals), 65 (16.1%) were moderate referrers (5 to 9 referrals), and 51 (12.7%) were high referrers (≥10 referrals). Solo practice (=.04) and no access to collaborative mental health services (<.001) were significantly associated with being a high referrer. Roughly 26.3% of low referrers, 29.2% of moderate referrers, and 15.4% of high referrers were satisfied with wait times for the service. Higher referrers did not identify a lack of comfort with providing psychiatric care as a driver of referrals; more indicated that they had a high volume of patients with mental health needs, that there was a lack of access to alternative services, and that patients sometimes requested referral. Overall, more than 40% of respondents expressed interest in a mental health care navigator, hard-copy resource information, and rapid access to consultation advice via telephone or an electronic platform. There was less interest in other proposed interventions.
CONCLUSION
We found referrers to the Centralized Psychiatric Consultation Service for Adults to be clustered based on specific practice characteristics, as well as provider-patient factors. Overall, satisfaction with the service was fair and PCPs were not highly interested in a variety of proposed interventions. Future studies should explore how useful 1-time consultation services are for solo-practising PCPs and how best to support these and other PCPs in their management of patients with mental health needs.
Topics: Male; Adult; Humans; Cross-Sectional Studies; Referral and Consultation; Mental Health Services; Physicians, Family; Personal Satisfaction
PubMed: 37451985
DOI: 10.46747/cfp.6907481 -
Therapeutic Innovation & Regulatory... Mar 2020Clinical research awareness, familiarity, referral proclivity, and practice have been assessed to varying degrees among US-based physicians specializing in oncology but...
BACKGROUND
Clinical research awareness, familiarity, referral proclivity, and practice have been assessed to varying degrees among US-based physicians specializing in oncology but very few studies have assessed these attitudes and behaviors among US physicians and nurses outside of oncology.
METHODS
To address this gap, the Tufts Center for the Study of Drug Development (Tufts CSDD) conducted a study of 589 US-based physicians and 1255 US-based nurses.
RESULTS AND CONCLUSIONS
US health care providers have very limited exposure to clinical research in medical and nursing school and in professional meetings. Very high percentages of multispecialty nurses and doctors view clinical trials as health care options, are interested in referring their patients into appropriate clinical trials, and are comfortable providing clinical trial information to, and discussing clinical trial opportunities with, their patients. Yet US physicians and nurses refer very small numbers of patients each year largely because of the inability to access clinical trial information, and the lack of sufficient information and time to evaluate and confidently discuss clinical trial options with their patients. Several factors are predictors of referral behavior, including proximity to research activity and past involvement in clinical research as an investigator, study coordinator, or study volunteer. The results of this study offer new insights into addressing low referral rates among US health care providers.
Topics: Attitude of Health Personnel; Health Personnel; Humans; Physicians; Referral and Consultation
PubMed: 32072594
DOI: 10.1007/s43441-019-00069-3 -
WMJ : Official Publication of the State... Oct 2021Timely, necessary specialist care is associated with better patient health outcomes and lower costs. This assessment looks at the effects of centralized scheduling, as...
BACKGROUND
Timely, necessary specialist care is associated with better patient health outcomes and lower costs. This assessment looks at the effects of centralized scheduling, as well as patient and referral-level factors on referral completion rates. We hypothesized that centralized scheduling would increase access to specialty care, as evidenced by higher referral completion rates.
METHODS
We analyzed data for specialty referrals to cardiology, nephrology, gastroenterology, and neurology from 6 months before to 6 months after implementation of a centralized scheduling system within a midwestern academic health system. We considered a referral complete if an appointment occurred within 3 months following an order for service.
RESULTS
Overall, referral completion rates modestly increased (63.7% to 69.9%, < 0.01), but this was driven by improvement within a single specialty (gastroenterology, 54.2% to 67.3%, < 0.05). Other specialties saw either no significant change (neurology, nephrology) or a decrease (cardiology, 87.3% to 78.6%, < 0.05). The time to schedule, or cycle time, improved overall from 21 days (SD 8-38) to 15 days (SD 8-30), <0.05.
CONCLUSIONS
Centralized scheduling had inconsistent effects on referral completion across specialties, though the process (cycle time) improved. Variable implementation fidelity and microenvironments likely contributed to uneven findings across specialties. Centralized scheduling may improve timely access but likely depends on implementation and buy-in.
Topics: Appointments and Schedules; Humans; Medicine; Referral and Consultation
PubMed: 34710301
DOI: No ID Found -
Telemedicine Journal and E-health : the... Jul 2022The coronavirus disease 2019 (COVID-19) pandemic forced many clinicians to rapidly adopt changes in their practice. In this study, we compared patterns of utilization...
The coronavirus disease 2019 (COVID-19) pandemic forced many clinicians to rapidly adopt changes in their practice. In this study, we compared patterns of utilization of Ontario eConsult before and after the onset of the COVID-19 pandemic, to assess COVID 19's impact on how eConsult is used. We conducted a longitudinal analysis of registration and utilization data for Ontario eConsult. All primary care providers (PCPs) and specialists who joined the service between March 2019 and November 2020, and all eConsult cases closed during the same period were included. The data were divided into two timeframes for comparison: prepandemic (March 2019-February 2020) and pandemic (March 2020-November 2020). In total, 5,925 PCPs joined during the study period, more than doubling total enrollment to 11,397. The average monthly number of eConsults increased from 2,405 (standard deviation [SD] = 260) prepandemic to 3,906 (SD = 420) pandemic. Case volume jumped to 24.3% in the first month of the pandemic, and increased by 71% during the COVID-19 pandemic timeframe. The median response time was similar in both timeframes (prepandemic: 1.0 days; pandemic: 0.9 days). The proportion of cases resulting in new/additional information (prepandemic: 55%, pandemic: 57%) or avoidance of a contemplated referral (prepandemic: 52%, pandemic: 51%) remained consistent between timeframes. Registration to and usage of eConsult increased during the pandemic. Metrics of the service's impact, including response time, percentage of cases resulting in new or additional information, and avoidance of originally contemplated referrals were all consistent between the prepandemic and COVID-19 pandemic timeframes, suggesting scalability.
Topics: COVID-19; Health Services Accessibility; Humans; Pandemics; Primary Health Care; Referral and Consultation; Remote Consultation
PubMed: 34861116
DOI: 10.1089/tmj.2021.0497 -
Journal of Safety Research Feb 2021Driver retirement and determination of fitness-to-drive are important aspects of reducing the risk of motor-vehicle collision for an older driver. A lack of information...
INTRODUCTION
Driver retirement and determination of fitness-to-drive are important aspects of reducing the risk of motor-vehicle collision for an older driver. A lack of information about the review process may lead to poor evaluation of drivers or an increased testing burden to referred drivers.
METHODS
This paper evaluates the license review process for the state of Iowa. We evaluated data from January 2014 to January 2018 and described the source of referral, testing process, and ultimate license disposition. Cox proportional hazards for competing risk were used to determine the risk of having a change in restrictions on the license and the risk of license denial.
RESULTS
20,742 individuals were followed through the medical referral process. The most common source of referrals was licensing officials (39.7%). Drivers referred by licensing officials were less likely to be denied their license when compared to drivers from other sources (HR = 0.92 95%CI: 0.87-0.98); however, licensing official referrals were more likely to result in license restrictions compared to other sources (HR = 1.91, 95%CI: 1.82-2.00). Drivers referred by either law enforcement or a physician were more likely to ultimately have their license denied.
CONCLUSIONS
Physician and law enforcement referred the drivers most likely to have their license denied. A smaller proportion of drivers were referred by physicians and law enforcement compared to licensing officials. Practical Applications: Licensing agencies should work with physicians and law enforcement to identify drivers who may need a review of their license. Comprehensive tracking of all medical referrals for a driver's license review is important for individual states to understand the burden of their driver referral process and for identifying referral sources with a high proportion of referrals with no licensing change for targeted outreach and education.
Topics: Accidents, Traffic; Aged; Aged, 80 and over; Automobile Driving; Female; Humans; Iowa; Licensure; Male; Middle Aged; Referral and Consultation
PubMed: 33653572
DOI: 10.1016/j.jsr.2020.12.001 -
Health Policy and Planning Feb 2021Effective referral is a critical element of a well-functioning health system. While having a good referral policy in place is important, equally important is its...
Effective referral is a critical element of a well-functioning health system. While having a good referral policy in place is important, equally important is its effective implementation. Using the implementation of a policy on referral of obstetric emergencies in Shanghai as a case, we illustrate the application of the 'Inhabited Institutions' analytical approach for studying policy implementation. In doing so, our study highlights how 'referral' is a quintessential systems process embedded in institutional, social and historical contexts. We show that multiple institutional logics, in the form of explicit and tacit organizing principles and assumptions, intersect to influence and shape actors' actions, sometimes with good outcomes and sometimes with poor outcomes. We reveal the embedded agency of frontline healthcare managers and providers across different levels of care. We show how frontline managers and providers, operating under conditions of uncertainties and ambiguities in organizational processes, actively draw upon their experience and network capital to creatively adapt to get referrals done in a timely manner to save lives of critically ill pregnant women. From our findings, two sets of linked implications emerge for strengthening referral systems. Given that referral often involves ill and complicated cases, getting referrals right depends on the exercise of discretion and judgement by those at the frontline to arrive at timely and workable solutions-health systems need to recognize this. We also conclude that to get referrals right, while one needs clearly defined policies and implementation processes that are locally appropriate, well understood by all concerned and easy to follow, this is not enough. In addition, explicit measures that enable the exercise of discretion and judgement at the frontline need to be locally identified and adopted.
Topics: China; Delivery of Health Care; Female; Government Programs; Humans; Policy Making; Pregnancy; Referral and Consultation
PubMed: 33141176
DOI: 10.1093/heapol/czaa091