-
Journal of Paediatrics and Child Health Apr 2019We aimed to introduce a low-cost combined online referral and immediate appointment selection system (CORIAS) to empower referrers and parents by allowing them to...
AIM
We aimed to introduce a low-cost combined online referral and immediate appointment selection system (CORIAS) to empower referrers and parents by allowing them to schedule an appointment at a time and location of their choosing in conjunction with the referrer at the time of referral. This was because an unacceptably high rate of reported lost referrals, combined with a high rate of failure to attend initial appointments (FTAs), was noted at a six-site community paediatric clinic service. We aimed to analyse the impact of CORIAS on important outcomes including timely appointment scheduling, attendance, loss of referrals, user acceptance, overall cost and administrative burden.
METHODS
For 3-month periods before and after the implementation of CORIAS, data were collected regarding all new referrals received and initial appointments scheduled, as well as reports of lost referrals. The number of attended initial appointments, FTAs, failures in successfully scheduling appointments, referrer background, CORIAS cost and qualitative feedback received from relevant parties was collated and analysed.
RESULTS
The proportion of referrals reported lost was 6% following the implementation of the combined online system in comparison to 17% pre-implementation. The FTA rate for scheduled initial appointments pre-implementation was 16%; post-implementation, the FTA rate was 9%. Qualitative benefits included a decrease in the administrative burden associated with appointment scheduling and increased service access for culturally and linguistically diverse families.
CONCLUSION
Appropriately designed and implemented novel online systems may improve timely and equitable access to health care by providing secure, reliable pathways for referrers and by empowering and improving communication with patients and families.
Topics: Ambulatory Care Facilities; Appointments and Schedules; Australia; Child; Child, Preschool; Community Health Services; Cost Savings; Cost-Benefit Analysis; Delivery of Health Care; Female; Hospitals, Pediatric; Humans; Internet; Male; Outcome Assessment, Health Care; Program Development; Program Evaluation; Referral and Consultation; Time Factors
PubMed: 30238684
DOI: 10.1111/jpc.14228 -
Scandinavian Journal of Primary Health... Feb 1988There are many unexplained differences in the rates at which general practitioners make referrals to other medical specialists. We investigated 5,082 referrals from 141...
There are many unexplained differences in the rates at which general practitioners make referrals to other medical specialists. We investigated 5,082 referrals from 141 general practitioners to dermatologists in Ringkøbing county in Denmark. As an expression of the referral rate to dermatologists an index of referral to dermatologists was estimated for every general practitioner. The index of referral to dermatologists was the number of referrals to the dermatologists per 1,000 patients per year, including children, standardized for age and sex to the average population in Ringkøbing County. The following six variables were evaluated in relation to the referral index: 1) Distance to the dermatologists, 2) number of doctors per practice, 3) number of consultations per general practitioner per year, 4) number of patients registered, 5) number of consultations per 1,000 patients per year standardized for age and sex, and 6) number of supplementary procedures per consultation. Stepwise multiple linear regression analysis was used. The study showed that the referral index to dermatologists fell both with distance to the dermatologist and with the number of supplementary procedures per consultation. No correlation was found between the referral index and the four other variables studied.
Topics: Denmark; Dermatology; Family Practice; Humans; Referral and Consultation
PubMed: 3353593
DOI: 10.3109/02813438809009286 -
BMC Pediatrics Apr 2012Recognition and referral of sick children to a facility where they can obtain appropriate treatment is critical for helping reduce child mortality. A well-functioning...
BACKGROUND
Recognition and referral of sick children to a facility where they can obtain appropriate treatment is critical for helping reduce child mortality. A well-functioning referral system and compliance by caretakers with referrals are essential. This paper examines referral patterns for sick children, and factors that influence caretakers' compliance with referral of sick children to higher-level health facilities in Afghanistan.
METHODS
The study was conducted in 5 rural districts of 5 Afghan provinces using interviews with parents or caretakers in 492 randomly selected households with a child from 0 to 2 years old who had been sick within the previous 2 weeks with diarrhea, acute respiratory infection (ARI), or fever. Data collectors from local nongovernmental organizations used a questionnaire to assess compliance with a referral recommendation and identify barriers to compliance.
RESULTS
The number of referrals, 99 out of 492 cases, was reasonable. We found a high number of referrals by community health workers (CHWs), especially for ARI. Caretakers were more likely to comply with referral recommendations from community members (relative, friend, CHW, traditional healer) than with recommendations from health workers (at public clinics and hospitals or private clinics and pharmacies). Distance and transportation costs did not create barriers for most families of referred sick children. Although the average cost of transportation in a subsample of 75 cases was relatively high (US$11.28), most families (63%) who went to the referral site walked and hence paid nothing. Most caretakers (75%) complied with referral advice. Use of referral slips by health care providers was higher for urgent referrals, and receiving a referral slip significantly increased caretakers' compliance with referral.
CONCLUSIONS
Use of referral slips is important to increase compliance with referral recommendations in rural Afghanistan.
Topics: Acute Disease; Afghanistan; Caregivers; Child, Preschool; Diarrhea; Fever; Health Care Surveys; Health Services Accessibility; Humans; Infant; Infant, Newborn; Parents; Patient Compliance; Referral and Consultation; Respiratory Tract Infections; Rural Health Services
PubMed: 22540424
DOI: 10.1186/1471-2431-12-46 -
Colorectal Disease : the Official... Mar 2007The 2-week wait (TWW) fast-track referral system for patients suspected of having colorectal cancer (CRC) has fallen well short of its expectations of streamlining... (Review)
Review
OBJECTIVE
The 2-week wait (TWW) fast-track referral system for patients suspected of having colorectal cancer (CRC) has fallen well short of its expectations of streamlining prioritization of colorectal referrals. Our study reviews most of the audits/studies that have been published on the system as its inception. Our aim was to identify where the shortcomings are and also to review the various alternatives that have recently been put forward.
METHOD
All articles on the TWW system published in mainstream peer reviewed journals were reviewed, as were all the abstracts on the system presented at the Association of Coloproctology and the British Society of Gastroenterology meetings. Implementation, compliance with guidelines, cancer detection rate, impact on waiting times and the overall effectiveness of the system are evaluated.
RESULTS
While the implementation of the system has been generally robust in most centres, the compliance with guidelines has been poor. This coupled with the inherently poor specificity of the system has resulted in a poor (and decreasing) cancer detection rate and a steadily growing volume of the hospital referrals. The system has been shown to have an adverse impact on the waiting times for routine colorectal referrals - a group that contributes significantly to the total number of CRC detected. The various alternatives to the TWW system that have been proposed recently, including our own, are discussed.
CONCLUSION
The shortcomings of the TWW system in its original form have now been demonstrated beyond doubt. What is needed is a fresh approach to find a cost effective and viable alternative in a climate of increased expectations and finite resources.
Topics: Colorectal Neoplasms; Guideline Adherence; Humans; Medical Audit; Practice Guidelines as Topic; Referral and Consultation; Retrospective Studies; Risk Factors; Time Factors; Waiting Lists
PubMed: 17298615
DOI: 10.1111/j.1463-1318.2006.01107.x -
BMC Health Services Research Jan 2020Timely access to emergency obstetric care is crucial in preventing mortalities associated with pregnancy and childbirth. The referral of patients from lower levels of...
BACKGROUND
Timely access to emergency obstetric care is crucial in preventing mortalities associated with pregnancy and childbirth. The referral of patients from lower levels of care to higher levels has been identified as an integral component of the health care delivery system in Ghana. To this effect, in 2012, the National Referral Policy and Guidelines was developed by the Ministry of Health (MOH) to help improve standard procedures and reduce delays which affect access to emergency care. Nonetheless, ensuring timely access to care during referral of obstetric emergencies has been problematic. The study aimed to identify barriers associated with the referral of emergency obstetric cases to the leading national referral centre. It specifically examines the lived experiences of patients, healthcare providers and relatives of patients on the referral system.
METHODS
Korle Bu Teaching Hospital, Accra was used as a case study in 2016.The qualitative method was used and in-depth interviews were conducted with 89 respondents: healthcare providers [n = 34];patients [n = 31] and relatives of patients [n = 24] using semi-structured interview guides. Purposive sampling techniques were used in selecting healthcare providers and patients and convenience sampling techniques were used in selecting relatives of patients.
RESULTS
The study identified a range of barriers encountered in the referral process and broadly fall under the major themes: referral transportation system, referrer-receiver communication barriers, inadequate infrastructure and supplies and insufficient health personnel. Some highlights of the problem included inadequate use of ambulance services, poor management of patients during transit, lack of professional escort, unannounced emergency referrals, lack of adequate information and feedback and limited supply of beds, drugs and blood. These findings have implications on type II and III of the three delays model.
CONCLUSIONS
Initiatives to improve the transportation system for the referral of obstetric emergencies are vital in ensuring patients' safety during transfer. Communication between referring and receiving facilities should be enhanced. A strong collaboration is needed between teaching hospitals and other stakeholders in the referral chain to foster good referral practices and healthcare delivery. Concurrently, supply side barriers at referred facilities including ensuring sufficient provision for bed, blood, drugs, and personnel must be addressed.
Topics: Delivery, Obstetric; Developing Countries; Emergency Medical Services; Female; Ghana; Health Services Accessibility; Humans; Pregnancy; Qualitative Research; Referral and Consultation; Tertiary Care Centers
PubMed: 31924203
DOI: 10.1186/s12913-020-4886-3 -
The Journal of Emergency Medicine Nov 2017Victims of intimate partner violence (IPV) frequently do not disclose abuse to medical providers. Therefore, research has examined the most effective screening and...
BACKGROUND
Victims of intimate partner violence (IPV) frequently do not disclose abuse to medical providers. Therefore, research has examined the most effective screening and referral methods to help identify victims of abuse and connect them to needed resources.
OBJECTIVES
To determine the efficacy of referrals intended to connect IPV victims with behavioral health resources, while taking into consideration demographic and mental health variables.
METHODS
We examined a convenience sample of medically stable individuals in an emergency department setting. Participants were given the Mini-International Neuropsychiatric Interview and Partner Violence Screen measures to assess mental health and IPV victimization. Individuals that screened positive were randomized to a basic or enhanced referral and given a follow-up interview to determine referral success. Referrals were considered successful if an individual scheduled an appointment with provided behavioral health resources within the follow-up interval.
RESULTS
Two-hundred and one individuals were enrolled. Forty-one (20.4%) participants screened positive for IPV victimization. Male and female participants in the enhanced referral group were more likely to have a successful referral than those in the basic referral group, with a large effect size such that 72.7% of participants in the enhanced referral and 15.7% of participants in the basic referral group contacted referral resources. Both referral type and marital status significantly predicted referral success.
CONCLUSION
Comorbidity with mental health concerns measured as high within those that screened positive for IPV victimization. The enhanced referral showed to be an effective way to encourage participants to contact behavioral health resources.
Topics: Adult; Chi-Square Distribution; Crime Victims; Emergency Service, Hospital; Female; Humans; Intimate Partner Violence; Male; Mass Screening; Middle Aged; Psychometrics; Referral and Consultation; Urban Population
PubMed: 28987297
DOI: 10.1016/j.jemermed.2017.06.044 -
Pediatrics Mar 2004Musculoskeletal medicine is becoming an increasingly essential part of primary care medicine. The American Academy of Pediatrics (AAP) Surgical Advisory Panel recently...
OBJECTIVE
Musculoskeletal medicine is becoming an increasingly essential part of primary care medicine. The American Academy of Pediatrics (AAP) Surgical Advisory Panel recently published voluntary guidelines to establish diagnoses that should be referred to a pediatric specialist rather than a general specialist (pediatric orthopedic surgery vs general orthopedic surgery). Given the crisis in pediatric orthopedic surgery manpower and resources, we believe that these guidelines are useful in defining appropriate referrals. The purpose of this study was to compare diagnoses that primary care pediatric providers believe commonly need referral to the AAP Guidelines for Referral to Pediatric Specialists recommendations for referral to pediatric orthopedic specialists.
METHODS
A chart review of successive new referrals (n = 286) to the pediatric orthopedic clinic during a 12-month period was conducted. The following information was collected: 1) diagnosis from referring provider, 2) diagnosis and treatment plan by the pediatric orthopedic surgeon, 3) type of referring provider (eg, pediatrician, family practitioner, resident physician, physician assistant), and 4) patient age. The referring diagnosis, final orthopedic diagnosis, and treatment plan for each patient was compared against the AAP Guidelines for Referral to Pediatric Specialists. The terms "appropriate" and "inappropriate" were used to differentiate those diagnoses that matched versus those that did not match the AAP Guidelines, respectively.
RESULTS
This analysis shows that a significant percentage (64.7%) of definitive diagnoses of referred cases were not consistent with the new AAP recommended guidelines for referral to pediatric orthopedic surgeons. In addition, a 23.8% (68 of 286) false-positive rate of referring diagnoses is noted. Cases that required no treatment or follow-up to monitor demonstrated a 32.8% (60 of 183) [(40 no treatment + 20 monitor inappropriate)/(116 no treatment + 67 monitor total)] false-positive rate.
CONCLUSIONS
Inappropriate referrals create a large use of pediatric orthopedic resources, which delays care of other, more appropriate patients. A large proportion of referrals indicated either a lack of basic textbook knowledge or lack of examination skills and appropriate diagnostic tools as demonstrated by a high number of definitive diagnosis indicating normal variants.
Topics: Adolescent; Child; Child, Preschool; Guideline Adherence; Humans; Infant; Orthopedics; Practice Guidelines as Topic; Referral and Consultation; United States
PubMed: 14993571
DOI: 10.1542/peds.113.3.e163 -
Occupational Medicine (Oxford, England) Apr 2021A rapid management referral pathway was established by a private UK occupational health (OH) provider to offer assessments and advice on managing individual risk...
BACKGROUND
A rapid management referral pathway was established by a private UK occupational health (OH) provider to offer assessments and advice on managing individual risk relating to Covid-19 in the workplace.
AIMS
The aim of this service evaluation was to assess the utilization and effectiveness of the pathway in supporting referrers during a pandemic.
METHODS
Referrals between March-August 2020 were analysed by date and industry to assess service utilization. A survey was sent to a convenience sample of referrers throughout this period, requesting feedback on whether the report led to a change in how the worker was managed, and whether it increased referrer confidence in managing the worker.
RESULTS
Five hundred and seventy referrals were made, predominantly from wholesale and retail; professional, scientific and technical; and food and drink production. There was a small peak of referrals from manufacturing in April and a larger peak in July-August from wholesale and retail, and food and drink production. Of 166 surveys sent, 58 were completed (35% response rate). In 71% of cases, referrers indicated that the report led to change in how the worker was managed, and in 86% of cases, referrers reported being more confident in managing the worker.
CONCLUSIONS
The pathway was well-utilized. OH assessments and advice have an important role to play in a pandemic, with useful impact on how workers are managed and how confident managers feel in managing workers.
Topics: COVID-19; Consultants; Humans; Industry; Occupational Exposure; Occupational Health; Occupations; Pandemics; Personnel Management; Referral and Consultation; Risk Management; SARS-CoV-2; Surveys and Questionnaires; United Kingdom; Workplace
PubMed: 33420507
DOI: 10.1093/occmed/kqaa223 -
Dental Update 2007It is beholden to the general dental practitioner to refer patients for whom (s)he feels that treatment could be carried out to a higher standard, or more efficiently...
UNLABELLED
It is beholden to the general dental practitioner to refer patients for whom (s)he feels that treatment could be carried out to a higher standard, or more efficiently and effectively, by another dentist. In addition, patients are entitled to a referral for a second opinion at any time. This paper discusses the responsibilities of the referring dentist and those of the dentist to whom the patient has been referred.
CLINICAL RELEVANCE
The experience of clinicians varies, so referral to another dentist may be appropriate if the patient's dental practitioner considers that treatment might be more effectively carried out by another dentist.
Topics: General Practice, Dental; Humans; Practice Management, Dental; Referral and Consultation
PubMed: 17784582
DOI: 10.12968/denu.2007.34.6.338 -
BMC Health Services Research Apr 2013Referral rates of general practitioners (GPs) are an important determinant of secondary care utilization. The variation in these rates across GPs is considerable, and...
High referral rates to secondary care by general practitioners in Norway are associated with GPs' gender and specialist qualifications in family medicine, a study of 4350 consultations.
BACKGROUND
Referral rates of general practitioners (GPs) are an important determinant of secondary care utilization. The variation in these rates across GPs is considerable, and cannot be explained by patient morbidity alone. The main objective of this study was to assess the GPs' referral rate to secondary care in Norway, any associations between the referral decision and patient, GP, health care characteristics and who initiated the referring issue in the consultation.
METHODS
The probabilities of referral to secondary care and/or radiological examination were examined in 100 consecutive consultations of 44 randomly chosen Norwegian GPs. The GPs recorded whether the issue of referral was introduced, who introduced it and if the patient was referred. Multilevel and naive multivariable logistic regression analyses were performed to explore associations between the probability of referral and patient, GP and health care characteristics.
RESULTS
Of the 4350 consultations included, 13.7% (GP range 4.0%-28.0%) of patients were referred to secondary somatic and psychiatric care. Female GPs referred significantly more frequently than male GPs (16.0% versus 12.6%, adjusted odds ratio, AOR, 1.25), specialists in family medicine less frequently than their counterparts (12.5% versus 14.9%, AOR 0.76) and salaried GPs more frequently than private practitioners (16.2% versus 12.1%, AOR 1.36).In 4.2% (GP range 0%-12.9%) of the consultations, patients were referred to radiological examination. Specialists in family medicine, salaried GPs and GPs with a Norwegian medical degree referred significantly more frequently to radiological examination than their counterparts (AOR 1.93, 2.00 and 1.73, respectively).The issue of referral was introduced in 23% of the consultations, and in 70.6% of these cases by the GP. The high referrers introduced the referral issue significantly more frequently and also referred a significantly larger proportion when the issue was introduced.
CONCLUSIONS
The main finding of the present study was a high overall referral rate, and a striking range among the GPs. Male GPs and specialists in family medicine referred significantly less frequently to secondary care, but the latter referred more frequently to radiological examination. Our findings indicate that intervention on high referrers is a potential area for quality improvement, and there is a need to explore the referral decision process itself.
Topics: Clinical Competence; Female; General Practitioners; Humans; Male; Practice Patterns, Physicians'; Referral and Consultation
PubMed: 23617296
DOI: 10.1186/1472-6963-13-147