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Canadian Family Physician Medecin de... Aug 2017To evaluate the response times to requests for consultations from FPs and the wait times for patient appointments.
OBJECTIVE
To evaluate the response times to requests for consultations from FPs and the wait times for patient appointments.
DESIGN
Mailed invitation to participate in a survey about non-FP specialist consultation requests from April 28 to May 9, 2014.
SETTING
Hamilton, Ont.
PARTICIPANTS
All active physicians with community practices from the Department of Family Medicine at St Joseph's Healthcare Hamilton and Hamilton Health Sciences.
MAIN OUTCOME MEASURES
All non-FP specialist consultation requests for a 2-week period.
RESULTS
Thirty-four practices (9.6% response rate) collected data on 816 consultation requests. Requests for referrals were most commonly made to the following 5 specialties: dermatology, surgery, gastroenterology, orthopedics, and obstetrics and gynecology. Overall, 36.4% of the requests for consultation received no response from the non-FP specialist's office by the end of the follow-up period. The mean wait time for a patient appointment was 60.1 days (range 23.3 to 168.5 days). Five specialties had particularly lengthy wait times of 105.9 to 168.5 days.
CONCLUSION
Allowing 5 to 7 weeks for a response from a non-FP specialist, there was still a 36.4% nonresponse rate (similar to a pilot survey administered in 2010). Patient and physician frustration is certainly heightened and more office time and energy is expended when no acknowledgment of a referral is received within 7 weeks. This gives our community wait times much longer than those reported by any of the national bodies.
Topics: Appointments and Schedules; Health Services Accessibility; Humans; Ontario; Outcome and Process Assessment, Health Care; Primary Health Care; Referral and Consultation; Specialization; Surveys and Questionnaires; Time Factors
PubMed: 28807959
DOI: No ID Found -
BMJ Open Sep 2021Many chronic eye conditions are managed within public hospital ophthalmology clinics resulting in encumbered wait lists. Integrated care schemes can increase system...
OBJECTIVES
Many chronic eye conditions are managed within public hospital ophthalmology clinics resulting in encumbered wait lists. Integrated care schemes can increase system capacity. In order to direct implementation of a public hospital-based integrated eye care model, this study aims to evaluate the quality of referrals for new patients through information content, assess triage decisions of newly referred patients and evaluate the consistency of referral content for new patients referred multiple times.
DESIGN
A retrospective and prospective review of all referral forms for new patients referred to a public hospital ophthalmology clinic between January 2016 and September 2017, and September 2017 and August 2018, respectively.
SETTING
A referral-only public hospital ophthalmology clinic in metropolitan Sydney, Australia.
PARTICIPANTS
418 new patients on existing non-urgent wait lists waiting to be allocated an initial appointment, and 528 patients who were newly referred.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was the information content of referrals for new patients. The secondary outcomes were triage outcomes for new incoming referrals, and the number of new patients with multiple referrals.
RESULTS
Of the wait-listed referrals, 0.2% were complete in referral content compared with 9.8% of new incoming referrals (p<0.001). Of new incoming referrals, 56.7% were triaged to a non-urgent clinic. Multiple referrals were received for 49 patients, with no change in the amount of referral content.
CONCLUSIONS
Most referrals were incomplete in content, leading to triage based on limited clinical information. Some new patients were referred multiple times with their second referral containing a similar amount of content as their first. Lengthy wait lists could be prevented by improving administrative processes and communication between the referral centre and referrers. The future implementation of an integrated eye care model at the study setting could sustainably cut wait lists for patients with chronic eye conditions.
Topics: Humans; Ophthalmology; Prospective Studies; Referral and Consultation; Retrospective Studies; Triage; Waiting Lists
PubMed: 34493511
DOI: 10.1136/bmjopen-2020-047246 -
BMC Public Health Jan 2024Health and wellbeing can be profoundly impacted by both obesity and type 2 diabetes, while the normalisation and equity of care for people living with these...
BACKGROUND
Health and wellbeing can be profoundly impacted by both obesity and type 2 diabetes, while the normalisation and equity of care for people living with these non-communicable diseases remain as challenges for local health systems. The National Health Service Low Calorie Diet programme in England, aims to support people to achieve type 2 diabetes remission, while also reducing health inequalities. We have explored the experiences of health care staff who have made a referral to the LCD programme, while identifying effective and equitable delivery of programme referrals, and their normalisation into routine care.
METHODS
Nineteen individual semi-structured interviews were completed health care staff in the first year of the Low Calorie Diet programme. Interviewees were purposively sampled from the ten localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest including communication and training, referrals, equity, and demands on primary care, before being subjected to a thematic analysis.
RESULTS
From the data, five core themes were identified: Covid-19 and the demands on primary care, the expertise and knowledge of referrers, patient identification and the referral process, barriers to referrals and who gets referred to the NHS LCD programme. Our findings demonstrate the variation in the real world settings of a national diabetes programme. It highlights the challenge of COVID-19 for health care staff, whereby the increased workload of referrals occurred at a time when capacity was curtailed. We have also identified several barriers to referral and have shown that referrals had not yet been normalised into routine care at the point of data collection. We also raise issues of equity in the referral process, as not all eligible people are informed about the programme.
CONCLUSIONS
Referral generation had not yet been consistently normalised into routine care, yet our findings suggest that the LCD programme runs the risk of normalising an inequitable referral process. Inequalities remain a significant challenge, and the adoption of an equitable referral process, normalised at a service delivery level, has the capacity to contribute to the improvement of health inequalities.
Topics: Humans; Caloric Restriction; Diabetes Mellitus, Type 2; State Medicine; COVID-19; Referral and Consultation
PubMed: 38200463
DOI: 10.1186/s12889-023-17526-2 -
Rural and Remote Health 2014This study aimed to examine whether general practitioner (GP) practice locations in remote and rural areas affected the pattern of direct access echocardiography...
INTRODUCTION
This study aimed to examine whether general practitioner (GP) practice locations in remote and rural areas affected the pattern of direct access echocardiography referral and to assess any variations in echocardiographic findings.
METHODS
All referrals made by all GP practices in the Scottish Highlands over a 36-month period were analysed. Referral patterns were examined according to distance and rurality based on the Scottish Government's Urban-Rural Classification. Reasons for referral and cardiac abnormality detection rates were also examined.
RESULTS
In total, 1188 referrals were made from 49 different GP practices; range of referral rates was 0.3-20.1 per 1000 population with a mean of 6.5 referrals per 1000 population. Referral rates were not significantly different between urban and rural practices after correction for population size. There was no correlation between the referral rates and the distance from the centre (r2=0.004, p=0.65). The most common reason for referral was the presence of new murmur (46%). The most common presenting symptom was breathlessness (44%). Overall, 28% of studies had significant abnormal findings requiring direct input from a cardiologist. There was no clear relationship between referral rates and cardiac abnormality detection rates (r2=0.07, p=0.37). The average cardiac abnormality detection rate was 56%, (range 52-60%), with no variation based on rurality (p=0.891).
CONCLUSIONS
In this cohort, rurality and distance were not barriers to an equitable direct access echocardiography service. Cardiac abnormality detection rates are consistent with that of other studies.
Topics: Ambulatory Care Facilities; Echocardiography; General Practitioners; Health Services Accessibility; Humans; Medical Audit; Referral and Consultation; Rural Health Services; Scotland
PubMed: 25494819
DOI: No ID Found -
Tropical Medicine & International... Jul 2020Reliable referral systems are essential to the functionality and efficiency of the wider health care system in low- and middle-income countries (LMICs), particularly in...
OBJECTIVES
Reliable referral systems are essential to the functionality and efficiency of the wider health care system in low- and middle-income countries (LMICs), particularly in surgery as the disease burden is growing while resources remain constrained and unevenly distributed. Yet, this is a critically under-researched area. This study aimed to provide a comprehensive assessment of surgical referral systems in a LMIC, Malawi, with a view to shedding light on this important aspect of public health and share lessons learned.
METHODS
We conducted a prospective analysis of all inter-hospital referrals received at Queen Elizabeth Central Hospital (QECH) in 2014-2015. A subsample of 255 referrals was assessed by three independent surgical experts against necessity and quality of the transfer to identify any inefficiencies in the referral process.
RESULTS
1317 patients were referred to QECH during the study period (average 53/month), 80% sent by government district hospitals. One in 3 cases were referred unnecessarily, many of which could have been managed locally. In 82% of cases, there was no communication with QECH prior to referral, 41% had incorrect/incomplete diagnosis by the referring clinicians and 39% of referrals were not timely.
CONCLUSIONS
Our findings provide the first evidence on the state of the surgical referral system in Malawi and contribute to building the body of knowledge necessary to inform system improvements. Responses should include reducing inappropriate use of specialist care and ensuring better care pathways for surgical patients, especially in rural areas, where access to specialist expertise is not available at present.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Health Resources; Hospitals, District; Humans; Infant; Infant, Newborn; Malawi; Male; Middle Aged; Poverty; Prospective Studies; Quality Improvement; Referral and Consultation; Surgical Procedures, Operative; Unnecessary Procedures; Young Adult
PubMed: 32324928
DOI: 10.1111/tmi.13406 -
Implementation of a quality improvement strategy to increase outpatient kidney transplant referrals.BMC Nephrology May 2020Kidney transplantation remains the optimal therapy for patients with end stage kidney disease (ESKD), though a small fraction of patients on dialysis are on organ...
BACKGROUND
Kidney transplantation remains the optimal therapy for patients with end stage kidney disease (ESKD), though a small fraction of patients on dialysis are on organ waitlists. An important barrier to both preemptive kidney transplantation and successful waitlisting is timely referral to a kidney transplant center. We implemented a quality improvement strategy to improve outpatient kidney transplant referrals in a single center academic outpatient nephrology clinic.
METHODS
Over a 3 month period (July 1-September 30, 2016), we assessed the baseline kidney transplantation referral rate at our outpatient nephrology clinic for patients 18-75 years old with an estimated glomerular filtration rate (eGFR) of less than 20 mL/min/1.73m (2 values over 90 days apart). Charts were manually reviewed by two reviewers to look for kidney transplant referrals and documentation of discussions about kidney transplantation. We then performed a root cause analysis to explore potential barriers to kidney transplantation. Our intervention began on July 1, 2017 and included the implementation of a column in the electronic medical record (EMR) which displayed the patient's last eGFR as part of the clinic schedule. In addition, physicians were given a document listing their patients to be seen that day with an eGFR of < 20 mL/min/1.73m. Annual education sessions were also held to discuss the importance of timely kidney transplant referral.
RESULTS
At baseline, 54 unique patients with eGFR ≤20 ml/min/1.73 m were identified who were seen in the Clinic between July 1, 2016 and September 30, 2016. 29.6% (16) eligible patients were referred for kidney transplantation evaluation. 69.5% (37) of these patients were not referred for kidney transplant evaluation. 46.3% (25) did not have documentation regarding kidney transplant in the EMR. nephrologist's most recent note. Following the intervention, 66 unique patients met criteria for eligibility for kidney transplant evaluation. Kidney transplant referrals increased to 60.6% (p < 0.001).
CONCLUSIONS
Our pilot implementation study of a strategy to improve outpatient kidney transplant referrals showed that a free, simple, scalable intervention can significantly improve kidney transplant referrals in the outpatient setting. This intervention targeted the nephrologist's role in the transplant referral, and facilitated the process of patient recognition and performing the referral itself without significantly interrupting the workflow. Next steps include further investigation to study the impact of early referral to kidney transplant centers on preemptive and living donor kidney transplantation as well as successful waitlisting.
Topics: Academic Medical Centers; Aged; Documentation; Electronic Health Records; Female; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Nephrology; Outpatient Clinics, Hospital; Physician's Role; Pilot Projects; Quality Improvement; Referral and Consultation
PubMed: 32434512
DOI: 10.1186/s12882-020-01855-0 -
The British Journal of General Practice... Jul 2017Older people with common mental health problems (CMHPs) are known to have reduced rates of referral to psychological therapy.
BACKGROUND
Older people with common mental health problems (CMHPs) are known to have reduced rates of referral to psychological therapy.
AIM
To assess referral rates to the Improving Access to Psychological Therapies (IAPT) services, contact with a therapist, and clinical outcome by age.
DESIGN AND SETTING
Empirical research study using patient episodes of care from South West of England IAPT services.
METHOD
By analysing 82 513 episodes of care (2010-2011), referral rates and clinical improvement were compared with both total population and estimated prevalence in each age group using IAPT data. Probable recovery of those completing treatment was calculated for each group.
RESULTS
Estimated prevalence of CMHPs peaks in 45-49-year-olds (20.59% of population). The proportions of patients identified with CMHPs being referred peaks at 20-24 years (22.95%) and reduces with increase in age thereafter to 6.00% for 70-74-year-olds. Once referred, the proportion of those attending first treatment increases with age between 20 years (57.34%) and 64 years (76.97%). In addition, the percentage of those having a clinical improvement gradually increases from the age of 18 years (12.94%) to 69 years (20.74%).
CONCLUSION
Younger adults are more readily referred to IAPT services. However, as a proportion of those referred, probabilities of attending once, attending more than once, and clinical improvement increase with age. It is uncertain whether optimum levels of referral have been reached for young adults. It is important to establish whether changes to service configuration, treatment options, and GP behaviour can increase referrals for middle-aged and older adults.
Topics: Adolescent; Adult; Age Distribution; Age Factors; Empirical Research; England; Female; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Health Services Research; Healthcare Disparities; Humans; Male; Mental Disorders; Mental Health Services; Middle Aged; Outcome Assessment, Health Care; Psychotherapy; Referral and Consultation; Young Adult
PubMed: 28583944
DOI: 10.3399/bjgp17X691361 -
The Angle Orthodontist Mar 2017To determine how often general dentists receive gifts from orthodontists, the value and number of the gifts they receive, and how they perceive the motivation behind the...
OBJECTIVES
To determine how often general dentists receive gifts from orthodontists, the value and number of the gifts they receive, and how they perceive the motivation behind the gift.
MATERIALS AND METHODS
This was a questionnaire-based study. A questionnaire was constructed and tested for validity and reliability. An electronic version of survey was sent via email to 1300 general dentists.
RESULTS
The validity and reliability of the survey was confirmed. Two hundred fifty-four valid responses were received (20%). Eighty-five percent of responding general practitioners reported that they received gifts from an orthodontist. Almost 100% reported that they referred patients to orthodontists. About one-third of the responding general practitioners reported that their office provided orthodontic care. There were statistically significant correlations between the number of annual patient referrals the general practitioners reported making and the number and value of the gifts they received from the orthodontists. Female general practitioners reported receiving a higher number of gifts of greater total value than male practitioners. General practitioners who reported providing orthodontic treatment did not differ from those who did not in the number of referrals they made annually and the number and value of the gifts they received. Quality of care was the most common reason general practitioners reported for their referral to an orthodontist. Forty-four percent of the responders reported that they received discounted orthodontic treatment.
CONCLUSIONS
General practitioners refer patients to orthodontists and receive gifts from them. The number and value of the gifts reflects the number of referrals they make.
Topics: Dentists; Gift Giving; Humans; Motivation; Orthodontists; Referral and Consultation; Surveys and Questionnaires
PubMed: 27654629
DOI: 10.2319/032416-242.1 -
BMC Health Services Research Nov 2021Over ten years on from a randomised controlled trial and subsequent national roll-out, the National Exercise Referral Scheme (NERS) continues to be routinely delivered... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Over ten years on from a randomised controlled trial and subsequent national roll-out, the National Exercise Referral Scheme (NERS) continues to be routinely delivered in primary care across Wales, UK. Few studies have revisited effective interventions years into their delivery in routine practice to understand how implementation, and perceived effects, have been maintained over time. This study explores perceptions and experiences of referral to NERS among referrers, scheme deliverers and patients.
METHODS
Individual, semi-structured interviews were conducted with 50 stakeholders: scheme referrers (n = 9); scheme deliverers (n = 22); and referred patients (n = 19). Convenience sampling techniques were used to recruit scheme referrers and purposive sampling to recruit scheme deliverers and patients. Thematic analysis was employed.
RESULTS
Analyses resulted in five key themes; referrer characteristics, geographical disparities in referral and scheme access, reinforcements for awareness of the scheme, patient characteristics and processes and context underpinning a referral. Overall there was a high concordance of views between all three stakeholder groups and barriers and facilitators were found to be entwined within and across themes. Referral barriers persisting since the earlier trial included a lack of consultation time and a lack of referral feedback. Newly identified barriers included a lack of scheme awareness and a referral system perceived to be time intensive and disjointed. Key referral facilitators included patient self-referrals, a growing scheme reputation and promotional activities of scheme deliverers.
CONCLUSIONS
Findings provide evidence that could inform the further development of NERS and wider exercise referral schemes to ensure the referral process is timely, efficient and equitable.
Topics: Exercise; Humans; Perception; Primary Health Care; Qualitative Research; Referral and Consultation; Wales
PubMed: 34774040
DOI: 10.1186/s12913-021-07266-7 -
JPMA. the Journal of the Pakistan... Dec 2021Competency in referral writing skill is needed by doctors for which they are not adequately trained. Although there has been a lot of discussion on improvement of skills...
Competency in referral writing skill is needed by doctors for which they are not adequately trained. Although there has been a lot of discussion on improvement of skills for writing consultation letters, still priority is not given to this important task. Ideally there should be a course with assessment for teaching and learning medical referral writing skills for students. Currently, there is no such tool to assess the way communication letters are written. An 18-point assessment scale has been developed through Delphi technique to improve the quality of referral letters. The objective of the present study was to design a structured Proforma for writing referrals, with the consensus of seven participants using Delphi. The place of study was Rawalpindi medical university and allied hospitals. Results were finalised after the acceptance of structured referral by selected participants through Delphi. The response rate was 70%. The validity and interrater reliability were calculated using SPSS25. The Cronbach's alpha was 0.7 and Kappa was 0.3. Both were statistically significant. The designed Proforma for writing referrals, with its interrater reliability calculated, seems effective for writing effective and structured referrals. The study further recommends training junior doctors in making effective referrals.
Topics: Communication; Consensus; Humans; Referral and Consultation; Reproducibility of Results; Writing
PubMed: 35150540
DOI: 10.47391/JPMA.01-1351