-
The British Journal of General Practice... Nov 1990The number of referrals made to a district psychiatry service by each of the local general practitioners over a five year period was counted and a large variation in...
The number of referrals made to a district psychiatry service by each of the local general practitioners over a five year period was counted and a large variation in general practitioner referral rate was found. Ten referral letters from each of the general practitioners were independently assessed for the amount of detail included and a mean score for each general practitioner obtained. A significant negative correlation was found between referral rate and amount of detail in referral letters, that is low referrers wrote very detailed letters. The procedure was repeated over an 18 month period including referrals to the district psychology service. Referral rate to the psychologists was positively correlated with detailed referral letters, that is those who referred many patients to the psychologists wrote detailed letters. This study has indicated a wide variation in the use of the psychiatry and psychology services by general practitioners which cannot be explained solely on the basis of a general referral tendency. It is likely that constructive liaison between psychiatrists and general practitioners, especially those who refer a large number of patients, could enhance the care of patients with psychiatric disorder in general practice.
Topics: Clinical Competence; Correspondence as Topic; England; Family Practice; Hospitals, District; Humans; Interprofessional Relations; Psychiatric Department, Hospital; Psychology, Medical; Referral and Consultation
PubMed: 2271277
DOI: No ID Found -
Health Policy (Amsterdam, Netherlands) Mar 2019Many specialist waitlists in Australian hospitals are long. One reason anecdotally reported for this is poor alignment of referrals with current recommended guidelines....
INTRODUCTION
Many specialist waitlists in Australian hospitals are long. One reason anecdotally reported for this is poor alignment of referrals with current recommended guidelines. This paper reports the findings of an audit undertaken in 2017 for ear, nose and throat (ENT) surgeon referrals submitted by primary health centres within Cape York, Australia.
MATERIALS AND METHODS
54 long-wait ENT referrals were reviewed against referral criteria for ENT presentations using the Clinical Prioritization Criteria (CPC) and two routinely applied clinical primary health care guidelines; with findings reported alongside patient demography.
RESULTS
All of the long wait ENT referrals in the sample were for remote living Indigenous Australians, most were children (93%). One fifth of referrals fulfilled all referral criteria and were appropriate (22%); one third required further informaiton to support the referral, either audiology or clinical history (30%); and half were inappropriate referrals (48%).
CONCLUSION
Although many referral submissions did not adhere to CPC or routine guidelines, this audit enabled the identification of improvements to the referral system including the development of a checklist and flow-chart, plus patient information resources aimed at improving patient adherence. A case can be made for a new service delivery model that provides ongoing primary health education and facilitates improved ENT access. These strategies may improve ENT referral quality and decongest current ENT specialist waitlists, while offering improved primary health care management of ear presentations.
Topics: Adult; Child; Child, Preschool; Ear Diseases; Female; Humans; Infant; Male; Middle Aged; Native Hawaiian or Other Pacific Islander; Queensland; Referral and Consultation; Waiting Lists
PubMed: 30638729
DOI: 10.1016/j.healthpol.2018.12.007 -
Applied Ergonomics Feb 2024The specialty referral process consists of primary care clinicians referring patients to specialty consultants. This care transition requires effective care coordination...
The specialty referral process consists of primary care clinicians referring patients to specialty consultants. This care transition requires effective care coordination and health information exchange between care teams; however, breakdowns in workflow and information flow impede "closing the referral loop" and delay or prevent referrers from receiving the consultant's "visit notes," particularly in cross-institutional referrals. This study aimed to describe and map the referral process as it occurs in clinics and identify and characterize work system barriers affecting its performance. Referrers and consultants were interviewed about their perceived workflows, barriers, and clinical outcomes to inform a workflow analysis.
Topics: Humans; Workflow; Health Facilities; Referral and Consultation
PubMed: 38016271
DOI: 10.1016/j.apergo.2023.104177 -
Journal of General Internal Medicine Jun 2003Patients' barriers to mental health services are well documented and include social stigma, lack of adequate insurance coverage, and underdiagnosis by primary care...
BACKGROUND
Patients' barriers to mental health services are well documented and include social stigma, lack of adequate insurance coverage, and underdiagnosis by primary care physicians. Little is known, however, about challenges primary care physicians face arranging mental health referrals and hospitalizations.
OBJECTIVE
To examine how practice setting and environment influence primary care physicians' ability to refer patients for medically necessary mental health services.
DESIGN
Cross-sectional analysis using nationally representative survey data from the 1998 to 1999 Community Tracking Study physician survey. The overall survey response rate was 61%.
PARTICIPANTS
A 1998 to 1999 telephone survey of 6586 primary care physicians.
MEASUREMENTS
Primary care physicians' report of whether they could obtain medically necessary referrals to high-quality mental health specialists or psychiatric admissions.
RESULTS
Overall, 54% of primary care physicians reported problems obtaining psychiatric hospital admissions, and 54% reported problems arranging outpatient mental health referrals. Primary care physicians practicing in staff and group model HMOs were much less apt to report difficulties than physicians in solo and small-group practices (P <.001). Reports of inadequate time with patients (P <.001) and smaller numbers of psychiatrists in a market area (P <.01) also were associated with problems obtaining mental health referrals. Pediatricians were more apt to report problems than general internists (P <.001).
CONCLUSIONS
Primary care physicians face greater hurdles obtaining mental health services than other medical services. Primary care is an important entry point for mental health services, yet inadequate referral systems between medical and mental health services may be hampering access.
Topics: Cross-Sectional Studies; Family Practice; Female; Gatekeeping; Health Care Surveys; Health Services Accessibility; Hospitals, Psychiatric; Humans; Longitudinal Studies; Male; Mental Health Services; Primary Health Care; Referral and Consultation; United States
PubMed: 12823651
DOI: 10.1046/j.1525-1497.2003.30216.x -
The British Journal of General Practice... Oct 2019Diagnosis of cancer as an emergency is associated with poor outcomes but has a complex aetiology. Examining determinants and time trends in diagnostic routes can help to...
BACKGROUND
Diagnosis of cancer as an emergency is associated with poor outcomes but has a complex aetiology. Examining determinants and time trends in diagnostic routes can help to appreciate the critical role of general practice over time in diagnostic pathways for patients with cancer.
AIM
To examine sociodemographic, cancer site, and temporal associations with type of presentation among patients with cancer diagnosed as emergencies.
DESIGN AND SETTING
Analysis of Routes to Diagnosis data, 2006-2015, for patients with cancer in England.
METHOD
The authors estimated adjusted proportions of emergency presentation after emergency GP referral (GP-EP) or presentation to accident and emergency (AE-EP), by patient sex, age, deprivation group, and year of diagnosis using multivariable regression.
RESULTS
Among 554 621 patients presenting as emergencies, 24% ( = 130 372) presented as GP-EP, 62% as AE-EP ( = 346 192), and 14% ( = 78 057) through Other-EP sub-routes. Patients presenting as emergencies were more likely to have been GP-referred if they lived in less deprived areas or were subsequently diagnosed with pancreatic, gallbladder, or ovarian cancer, or acute leukaemia. During the study period the proportion and number of GP-EPs nearly halved (31%, = 17 364, in 2006; 17%, = 9155 in 2015), while that of AE-EP increased (55%, = 31 049 to 68%, = 36 868).
CONCLUSION
Patients presenting as emergencies with cancers characterised by symptoms/signs tolerable by patients but appropriately alarming to doctors (for example, pancreatic cancer manifesting as painless jaundice) are over-represented among cases whose emergency presentation involved GP referral. Reductions in diagnoses of cancer through an emergency presentation likely reflect both the continually increasing use of 2-week-wait GP referrals during the study period and reductions in emergency GP referrals.
Topics: Adult; Aged; Aged, 80 and over; Emergencies; Emergency Service, Hospital; England; Female; General Practice; Humans; Male; Middle Aged; Neoplasms; Referral and Consultation
PubMed: 31455644
DOI: 10.3399/bjgp19X705473 -
The Journal of Family Planning and... Oct 2012Women seeking abortion services need to access services in a timely fashion. Quick and appropriate referrals to abortion providers are critical to this process.
BACKGROUND
Women seeking abortion services need to access services in a timely fashion. Quick and appropriate referrals to abortion providers are critical to this process.
METHODS
The objective of this study was to determine the quality and quantity of referrals for abortion services from reproductive health care facilities that do not provide abortion services. USA states were ranked by restrictiveness of abortion, and a simulated patient made calls to the five most and six least restrictive states. Referrals were considered direct if the name or telephone number of a facility that provided abortion services was given; indirect when Planned Parenthood was suggested without additional details; and inappropriate if the referral did not provide abortion services.
RESULTS
Of 142 calls, 77 (52.4%) were made to least restrictive states and 62 (45.8%) were made to most restrictive states. Among all calls, even after prompting staff members for a referral, 45.8% resulted in a direct referral, 19.0% resulted in an indirect referral, 8.5% resulted in an inappropriate referral and 26.8% resulted in no referral. Facilities in least restrictive states were significantly more likely to provide unprompted direct referrals (p=0.006) and significantly less likely to provide no referral (p<0.001) than facilities in most restrictive states, though these differences disappeared after prompting the staff member to provide a referral.
CONCLUSIONS
A simulated patient received a direct referral for abortion services less than half the time, even after prompting a staff member to provide one. All facilities providing women's health care should have appropriate referrals readily available for patients seeking abortion services.
Topics: Abortion, Induced; Health Services Accessibility; Patient Simulation; Referral and Consultation; United States
PubMed: 22262620
DOI: 10.1136/jfprhc-2011-100176 -
The British Journal of General Practice... Apr 2000Previous research has shown that mental disorder in the community has remained fairly constant over the past 30 years. As a result there has been a shift in mental...
Previous research has shown that mental disorder in the community has remained fairly constant over the past 30 years. As a result there has been a shift in mental health care from primary care to specialised mental health care. This shift should be visible in higher referral figures from general practice. In this longitudinal analysis of mental health referrals (1971 to 1997), the authors aimed to answer whether these higher referral rates have occurred, whether there are increases in referral for specific groups, and whether the referral pattern has changed. The results demonstrate an increase in referral rate with a factor of 4.5. It is concluded that we are witnessing a pull from mental health care together with a push from general practice, thus reinforcing each other.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Family Practice; Female; Humans; Infant; Infant, Newborn; Longitudinal Studies; Male; Mental Disorders; Mental Health Services; Middle Aged; Netherlands; Referral and Consultation
PubMed: 10897516
DOI: No ID Found -
JAMA Network Open Jul 2020Specialist gender clinics worldwide have witnessed an increase in referrals of transgender and gender diverse (TGD) children and adolescents, but the underlying factors...
Association of Media Coverage of Transgender and Gender Diverse Issues With Rates of Referral of Transgender Children and Adolescents to Specialist Gender Clinics in the UK and Australia.
IMPORTANCE
Specialist gender clinics worldwide have witnessed an increase in referrals of transgender and gender diverse (TGD) children and adolescents, but the underlying factors associated with this increase are unknown.
OBJECTIVE
To determine whether increases in TGD young people presenting to specialist gender clinics are associated with related media coverage.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study was conducted at 2 publicly funded, pediatric specialist gender services, one located in the UK and the other in Australia. Participants were all children and adolescents aged 0 to 18 years, referred between January 1, 2009, and December 31, 2016, to their respective gender services in the UK and Australia. Data analysis was performed in April 2019.
EXPOSURES
Media coverage of TGD issues.
MAIN OUTCOMES AND MEASURES
Referral rates from each gender service were compared with local TGD-related media coverage during the study period.
RESULTS
Referral data for 5242 TGD young people were obtained (4684 in the UK, of whom 1847 [39.4%] were assigned male at birth and 2837 [60.6%] were assigned female at birth; 558 in Australia, of whom 250 [44.8%] were assigned male at birth and 308 [55.2%] were assigned female at birth), and a total of 2614 news items were identified (UK, 2194; Australia, 420). The annual number of TGD young people referred to both specialist gender clinics was positively correlated with the number of TGD-related local media stories appearing each year (Spearman r = 1.0; P < .001). Moreover, weekly referral rates in both the UK for week 1 (β̂ = 0.16; 95% CI, 0.03-0.29; P = .01) and Australia for week 2 (β̂ = 0.12; 95% CI, 0.04-0.20; P = .003) showed evidence of association with the number of TGD-related media items appearing within the local media. There was no evidence of association between referrals and media items appearing 3 weeks beforehand. Media predominantly focused on TGD issues showed some association with increased referral rates. Specifically, TGD-focused stories showed evidence of association with referral numbers at week 1 (β̂ = 0.16; 95% CI, 0.04-0.28; P = .007) and week 2 (β̂ = 0.23; 95% CI, 0.11-0.35; P < .001) in Australia and with referral numbers at week 1 (β̂ = 0.22; 95% CI, 0.01-0.44; P = .04) in the UK. No evidence of association was found between media peripherally related to TGD issues and referral rates.
CONCLUSIONS AND RELEVANCE
This study found evidence of an association between increasing media coverage of TGD-related topics and increasing numbers of young people presenting to gender clinics. It is possible that media coverage acts as a precipitant for young people to seek treatment at specialist gender services, which is consistent with clinical experiences in which TGD young people commonly identify the media as a helpful source of information and a trigger to seek assistance.
Topics: Adolescent; Ambulatory Care Facilities; Australia; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Interpersonal Relations; Male; Mass Media; Referral and Consultation; Transgender Persons; United Kingdom
PubMed: 32721030
DOI: 10.1001/jamanetworkopen.2020.11161 -
Journal of Glaucoma Feb 2017To identify characteristics of ophthalmologists and practices who refer glaucoma patients to low vision services (LVS).
PURPOSE
To identify characteristics of ophthalmologists and practices who refer glaucoma patients to low vision services (LVS).
MATERIALS AND METHODS
An online survey was distributed to members of the American Glaucoma Society. The survey queried demographics of responders and their clinical practices, criteria and barriers to referral to LVS. Survey responders were categorized as high referrers if they reported referring >5 patients to LVS and low referrers if they referred ≤5. χ and Fischer exact tests were used to compare characteristics between high and low referrers. Logistic regression analyses were used to calculate odds ratios and 95% confidence intervals and determine factors associated with referrer status.
RESULTS
High referrers to LVS tended to have >10 patients per month who had already seen a low vision provider (53% vs. 10%, P<0.001), reported following the American Academy of Ophthalmology's Preferred Practice Pattern (PPP) recommendations for LVS referrals (38% vs. 18%, P=0.011), and expressed satisfaction with their current referral practices (86% vs. 70%, P=0.049). In the fully adjusted model those who followed PPP were 2.5 times more likely to report being a high referrer as compared with a low referrer (95% confidence interval, 1.1-5.3). However, only 22% of ophthalmologists reported following these guidelines in their practice. The number of years in practice, practice location or type, volume of patients seen each week, and distance to a low vision clinic were not associated with referral.
CONCLUSIONS
Familiarity with PPP guidelines may positively influence LVS referral practices.
Topics: Aged; Female; Glaucoma; Humans; Intraocular Pressure; Male; Middle Aged; Ophthalmologists; Practice Patterns, Physicians'; Referral and Consultation; Surveys and Questionnaires; Vision, Low
PubMed: 27977474
DOI: 10.1097/IJG.0000000000000600 -
Healthplan 1997
Topics: Computer Communication Networks; Efficiency, Organizational; Female; Health Maintenance Organizations; Humans; Male; Medicine; Referral and Consultation; Specialization; Work Simplification
PubMed: 10176860
DOI: No ID Found