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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 -
What is the impact of primary care model type on specialist referral rates? A cross-sectional study.BMC Family Practice Feb 2014Several new primary care models have been implemented in Ontario, Canada over the past two decades. These practice models differ in team structure, physician...
BACKGROUND
Several new primary care models have been implemented in Ontario, Canada over the past two decades. These practice models differ in team structure, physician remuneration, and group size. Few studies have examined the impact of these models on specialist referrals. We compared specialist referral rates amongst three primary care models: 1) Enhanced Fee-for-service, 2) Capitation- Non-Interdisciplinary (CAP-NI), 3) Capitation - Interdisciplinary (CAP-I).
METHODS
We conducted a cross-sectional study using health administrative data from primary care practices in Ontario from April 1st, 2008 to March 31st, 2010. The analysis included all family physicians providing comprehensive care in one of the three models, had at least 100 patients, and did not have a prolonged absence (eight consecutive weeks). The primary outcome was referral rate (# of referrals to all medical specialties/1000 patients/year). A multivariable clustered Poisson regression analysis was used to compare referral rates between models while adjusting for provider (sex, years since graduation, foreign trained, time in current model) and patient (age, sex, income, rurality, health status) characteristics.
RESULTS
Fee-for-service had a significantly lower adjusted referral rate (676, 95% CI: 666-687) than the CAP-NI (719, 95% confidence interval (CI): 705-734) and CAP-I (694, 95% CI: 681-707) models and the interdisciplinary CAP-I group had a 3.5% lower referral rate than the CAP-NI group (RR = 0.965, 95% CI: 0.943-0.987, p = 0.002). Female and Canadian-trained physicians referred more often, while female, older, sicker and urban patients were more likely to be referred.
CONCLUSIONS
Primary care model is significantly associated with referral rate. On a study population level, these differences equate to 111,059 and 37,391 fewer referrals by fee-for-service versus CAP-NI and CAP-I, respectively - a difference of $22.3 million in initial referral appointment costs. Whether a lower rate of referral is more appropriate or not is not known and requires further investigation. Physician remuneration and team structure likely account for the differences; however, further investigation is also required to better understand whether other organizational factors associated with primary care model also impact referral.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Infant; Male; Middle Aged; Models, Organizational; Ontario; Primary Health Care; Referral and Consultation; Young Adult
PubMed: 24490703
DOI: 10.1186/1471-2296-15-22 -
Optometry (St. Louis, Mo.) Sep 2011
Topics: Clinical Competence; Humans; Optometry; Referral and Consultation; Vision Disorders
PubMed: 21871392
DOI: 10.1016/j.optm.2011.07.011 -
Irish Journal of Medical Science Feb 2016Referrals to symptomatic breast clinics have increased significantly in recent years with unchanged numbers of detected cancers. The general practitioner (GP) referral...
BACKGROUND
Referrals to symptomatic breast clinics have increased significantly in recent years with unchanged numbers of detected cancers. The general practitioner (GP) referral information relating to this increased patient volume causes anxiety and potentially creates confusion and future medicolegal issues if inaccurate.
AIMS
To compare GP triage category requests and clinical findings with those determined by the breast centre.
METHODS
1,014 consecutive referrals to a symptomatic breast service were included. GP triage request category and clinical findings were prospectively recorded and compared to cancer centre surgeon triage category, clinical findings and cancer detection rates.
RESULTS
GPs requested urgent appointments for 49 % of referrals, only 22 % were considered urgent on triage at the cancer centre. The triage category request was downgraded in 56 % of referrals from urgent to routine. Thirty-three cancers were detected, representing 3 % of referrals. Eighty-eight percent of cancers were identified in the group with positive clinical findings at the breast clinic. 24 % of the new referrals were for mastalgia alone. In the 55 % of referred cases where GPs reported a clinical abnormality, only 39 % of these had a clinical finding confirmed by the breast surgeon.
CONCLUSIONS
There is poor correlation between GP triage category request and those assigned by the breast unit. GP referrals indicating patients with a clinical abnormality was discordant with specialist findings in 61% of cases. The frequency of overstating of clinical findings by GPs is such that subsequent cancer diagnosis does not imply failure of a preceding triple assessment process.
Topics: Adult; Aged; Appointments and Schedules; Breast; Female; General Practitioners; Humans; Mastodynia; Middle Aged; Referral and Consultation; Specialization; Triage
PubMed: 25422062
DOI: 10.1007/s11845-014-1223-z -
BMC Psychiatry Nov 2016Consultation-Liaison Psychiatry (CLP) is a subspecialty of psychiatry that provides care to inpatients under non-psychiatric care. Despite evidence of benefits of CLP... (Review)
Review
BACKGROUND
Consultation-Liaison Psychiatry (CLP) is a subspecialty of psychiatry that provides care to inpatients under non-psychiatric care. Despite evidence of benefits of CLP for inpatients with psychiatric comorbidities, referral rates from hospital doctors remain low. This review aims to understand barriers to CLP inpatient referral as described in the literature.
METHODS
We searched on Medline, PsychINFO, CINAHL and SCOPUS, using MESH and the following keywords: 1) Consultation-Liaison Psychiatry, Consultation Liaison Psychiatry, Consultation Psychiatry, Liaison Psychiatry, Hospital Psychiatry, Psychosomatic Medicine, the 2) Referral, Consultation, Consultancy and 3) Inpatient, Hospitalized patient, Hospitalized patient. We considered papers published between 1 Jan 1965 and 30 Sep 2015 and all articles written in English that contribute to understanding of barriers to CLP referral were included.
RESULTS
Thirty-five eligible articles were found and they were grouped thematically into three categories: (1) Systemic factors; (2) Referrer factors; (3) Patient factors. Systemic factors that improves referrals include a dedicated CLP service, active CLP consultant and collaborative screening of patients. Referrer factors that increases referrals include doctors of internal medicine specialty and comfortable with CLP. Patients more likely to be referred tend to be young, has psychiatric history, live in an urban setting or has functional psychosis.
CONCLUSION
This is the first systematic review that examines factors that influence CLP inpatient referrals. Although there is research in this area, it is of limited quality. Education could be provided to hospital doctors to better recognise mental illness. Collaborative screening of vulnerable groups could prevent inpatients from missing out on psychiatric care. CLP clinicians should use the knowledge gained in this review to provide quality engagement with referrers.
Topics: Health Services Accessibility; Hospitals; Humans; Inpatients; Mental Health Services; Physicians; Psychiatry; Referral and Consultation
PubMed: 27829386
DOI: 10.1186/s12888-016-1100-6 -
The Cochrane Database of Systematic... Oct 2008The primary care specialist interface is a key organisational feature of many health care systems. Patients are referred to specialist care when investigation or... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The primary care specialist interface is a key organisational feature of many health care systems. Patients are referred to specialist care when investigation or therapeutic options are exhausted in primary care and more specialised care is needed. Referral has considerable implications for patients, the health care system and health care costs. There is considerable evidence that the referral processes can be improved.
OBJECTIVES
To estimate the effectiveness and efficiency of interventions to change outpatient referral rates or improve outpatient referral appropriateness.
SEARCH STRATEGY
We conducted electronic searches of the Cochrane Effective Practice and Organisation of Care (EPOC) group specialised register (developed through extensive searches of MEDLINE, EMBASE, Healthstar and the Cochrane Library) (February 2002) and the National Research Register. Updated searches were conducted in MEDLINE and the EPOC specialised register up to October 2007.
SELECTION CRITERIA
Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of interventions to change or improve outpatient referrals. Participants were primary care physicians. The outcomes were objectively measured provider performance or health outcomes.
DATA COLLECTION AND ANALYSIS
A minimum of two reviewers independently extracted data and assessed study quality.
MAIN RESULTS
Seventeen studies involving 23 separate comparisons were included. Nine studies (14 comparisons) evaluated professional educational interventions. Ineffective strategies included: passive dissemination of local referral guidelines (two studies), feedback of referral rates (one study) and discussion with an independent medical adviser (one study). Generally effective strategies included dissemination of guidelines with structured referral sheets (four out of five studies) and involvement of consultants in educational activities (two out of three studies). Four studies evaluated organisational interventions (patient management by family physicians compared to general internists, attachment of a physiotherapist to general practices, a new slot system for referrals and requiring a second 'in-house' opinion prior to referral), all of which were effective. Four studies (five comparisons) evaluated financial interventions. One study evaluating change from a capitation based to mixed capitation and fee-for-service system and from a fee-for-service to a capitation based system (with an element of risk sharing for secondary care services) observed a reduction in referral rates. Modest reductions in referral rates of uncertain significance were observed following the introduction of the general practice fundholding scheme in the United Kingdom (UK). One study evaluating the effect of providing access to private specialists demonstrated an increase in the proportion of patients referred to specialist services but no overall effect on referral rates.
AUTHORS' CONCLUSIONS
There are a limited number of rigorous evaluations to base policy on. Active local educational interventions involving secondary care specialists and structured referral sheets are the only interventions shown to impact on referral rates based on current evidence. The effects of 'in-house' second opinion and other intermediate primary care based alternatives to outpatient referral appear promising.
Topics: Controlled Clinical Trials as Topic; Economics, Medical; Family Practice; Humans; Information Dissemination; Medicine; Outpatients; Practice Guidelines as Topic; Primary Health Care; Referral and Consultation; Specialization
PubMed: 18843691
DOI: 10.1002/14651858.CD005471.pub2 -
Clinical Neurology and Neurosurgery Sep 2016Diagnostic procedures are often overused in the attempt to substitute for the good clinical examination. The aim of this study was to evaluate the type and the accuracy...
OBJECTIVE
Diagnostic procedures are often overused in the attempt to substitute for the good clinical examination. The aim of this study was to evaluate the type and the accuracy of the referral diagnosis to our EMG lab, as well as the impact of electrodiagnostic (EDX) examination on the diagnosis of our patients.
METHODS
In this prospective study all patients examined in the six months period in a single tertiary referral EMG lab were analyzed. All patients were tested in a uniform fashion and by the same neurologist, according to the referral diagnosis.
RESULTS
EDX examination was performed in 570 patients. Most of the patients (43.9%) were referred with the diagnosis of polyneuropathy, lumbosacral (23.7%) or cervical (11.2%) radiculopathy and myasthenia gravis (11.6%). The outcome after EDX examination was: diagnosis confirmation in 49.6% of patients, new clinically relevant diagnosis in 16%, incidental diagnosis in 4% and normal EDX examination in 36.1% of patients. EDX examination confirmed referral diagnosis more often in patients referred by neuromuscular neurologists, while normal EDX finding was reported more often in patients referred by other neurologists.
CONCLUSION
This study has confirmed the inappropriateness of a large number of referrals to EDX testing, especially made by the non-neuromuscular neurologists.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Electromyography; Female; Humans; Male; Middle Aged; Neuromuscular Diseases; Peripheral Nervous System Diseases; Prospective Studies; Referral and Consultation; Tertiary Care Centers; Young Adult
PubMed: 27448045
DOI: 10.1016/j.clineuro.2016.07.021 -
The International Journal of Behavioral... Dec 2020Physical Activity Referral Schemes (PARS), including exercise referral schemes, are a popular approach to health improvement, but understanding of effectiveness is...
BACKGROUND
Physical Activity Referral Schemes (PARS), including exercise referral schemes, are a popular approach to health improvement, but understanding of effectiveness is limited by considerable heterogeneity in reporting and evaluation. We aimed to gain consensus for a PARS taxonomy as a comprehensive method for reporting and recording of such schemes.
METHODS
We invited 62 experts from PARS policy, research and practice to complete a modified Delphi study. In round one, participants rated the need for a PARS taxonomy, the suitability of three proposed classification levels and commented on proposed elements. In round two, participants rated proposed taxonomy elements on an 11-point Likert scale. Elements scoring a median of ā„7, indicating high agreement, were included in the final taxonomy.
RESULTS
Of those invited, 47 (75.8%) participated in round one, with high retention in round two (nā=ā43; 91.5%). 42 were UK-based, meaning the resultant taxonomy has been scrutinised for fit to the UK context only. The study gained consensus for a three-level taxonomy: Level 1: PARS classification (primary classification, provider, setting, conditions accepted [have or at risk of], activity type and funding). Level 2: scheme characteristics (staff structure, staff qualifications, behaviour change theories, behaviour change techniques, referral source, referrers, referral process, scheme duration, session frequency, session length, session times, session type, exit routes, action in case of non-attendance, baseline assessment, exit assessment, feedback to referrer and exclusion criteria) and Level 3: participant measures (demographics, monitoring and evaluation, and measures of change).
CONCLUSION
Using a modified Delphi method, this study developed UK-based consensus on a PARS classification taxonomy. We encourage PARS practitioners and public health colleagues, especially those working with similar service models internationally, to test, refine and use this taxonomy to inform policy and practice.
Topics: Adult; Behavior Therapy; Consensus; Delphi Technique; Exercise; Exercise Therapy; Humans; Public Health; Referral and Consultation; Research Design; United Kingdom
PubMed: 33267840
DOI: 10.1186/s12966-020-01050-2 -
BMC Research Notes May 2014Telephone counseling Quitlines can support smoking cessation, but are under-utilized. We explored the use of smoker peer-referrals to increase use of a Quitline in...
BACKGROUND
Telephone counseling Quitlines can support smoking cessation, but are under-utilized. We explored the use of smoker peer-referrals to increase use of a Quitline in Mississippi and Alabama.
FINDINGS
Collaborating with the Alabama and Mississippi Quitline, we piloted peer-referrals to Quitlines. Successful 'quitters' who had used the Quitline were contacted at routine follow-up and recruited to participate as a peer-referrer and refer their friends and family who smoked to the Quitline. Peer-referrers completed a training session, received a manual and a set of Quitline brochures a peer-referral forms. These peer-referral forms were then returned to the Quitline telephone counselors who proactively called the referred smokers. Of the initial potential pool of 96 who quit using the Quitline, 24 peer-referrers (75% Women, 29% African-American, and high school graduates/GED 67%) were recruited and initially agreed to participate as peer-referrers. Eleven of the 24 who initially agreed were trained, and of these 11, 4 (4%) actively referred 23 friends and family over 2 months. From these 23 new referrals, three intakes (100% Women, 66% African-American) were completed. Of the initial pool of 96, 4 (4%) actively participated in referring friends and family. Quitline staff and peer-referrers noted several barriers including: time-point in which potential peer-referrers were asked to participate, an 'overwhelming' referral form to use and limited ways to refer.
CONCLUSIONS
Though 'quitters' were willing to agree to peer-refer, we received a minority of referrals. However, we identified several areas to improve this new method for increasing awareness and access to support systems like the Quitline for smokers who want to quit.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Peer Group; Pilot Projects; Referral and Consultation; Smoking; Smoking Cessation; Young Adult
PubMed: 24886693
DOI: 10.1186/1756-0500-7-282 -
Dementia (London, England) Jul 2020To assess the extent of UK speech and language therapy engagement in assessment and management of primary progressive aphasia, determine the factors contributing to any...
OBJECTIVE
To assess the extent of UK speech and language therapy engagement in assessment and management of primary progressive aphasia, determine the factors contributing to any shortfall and explore a gap in the research literature on current speech and language therapy practices with people with primary progressive aphasia.
METHODS
A 37-item, pilot-tested survey was distributed electronically via clinical networks and through the Royal College of Speech and Language Therapists. Survey items included questions on intervention approaches, referral numbers and demographics, referral sources and access to services.
RESULTS
One hundred and five speech and language therapists completed the survey. Over the previous 24 months, respondents reported seeing a total of 353 people with primary progressive aphasia (an average of 3.27 per speech and language therapist). Neurologists were the most commonly reported referrers to speech and language therapy (22.5%). Seventy-eight percent of respondents reported that people with primary progressive aphasia experienced barriers to accessing speech and language therapy. Key barriers were a lack of referrer awareness of a speech and language therapist's role, and restrictive eligibility criteria for services.
CONCLUSIONS
This study highlighted inequities in access to speech and language therapy for people with primary progressive aphasia. The medical and speech and language therapy professions need to develop appropriate care pathways for people with primary progressive aphasia. Speech and language therapists have a duty to develop a relevant evidence base for speech and language interventions for people with primary progressive aphasia.
Topics: Aged; Aphasia, Primary Progressive; Eligibility Determination; Health Services Accessibility; Humans; Internet; Language Therapy; Middle Aged; Needs Assessment; Referral and Consultation; Speech Therapy; Surveys and Questionnaires; United Kingdom
PubMed: 30180763
DOI: 10.1177/1471301218797240