The process of outpatient referral and care: the experience and views of patients, their general practitioners, and specialists

Royal Free and University College London Medical School.
British Journal of General Practice (Impact Factor: 2.29). 03/2000; 50(451):116-20.
Source: PubMed


The primary care system in the United Kingdom, involving the general practitioner (GP) as gatekeeper to further services, has helped to keep health care costs down. Despite this, unexplained variation in referral rates and increasing health care costs have led to the search for methods of improving efficiency. There is relatively little recent descriptive data on the processes of care at the primary-secondary care interface. The study reported here provides information about this.
To analyse the patterns and process of care for the referral of outpatients, together with the views of patients, their GPs, and specialists.
A questionnaire survey of outpatients, their hospital specialists, and GPs in randomly sampled district health authorities in the North Thames Region. The measures included items and scales measuring satisfaction and processes.
Almost all of the outpatients thought that their consultation with the specialist was 'necessary' and 'worthwhile'. Most of the GPs felt that they could not have given the study patients the care, treatment, and investigations they received in hospital, and most of the sampled patients' attendances were rated by the specialists as 'appropriate'. However, for just over one-fifth of new patients, the specialists reported that the GP could have done more tests and examinations prior to referring the study patient. Large proportions of GPs in this survey also reported having technical equipment in their practices, as well as direct access to a range of services and hospital-based facilities.
A large amount of work is carried out in general practice prior to the hospital referral of patients, and GPs have direct access to some technologies and services that can act to reduce the burden on hospitals. The discrepancy between GPs' and specialists, perceptions about the potential for further investigative work prior to patient referral merits further investigation.

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    • "GPs write more than 10 million elective referral letters each year for routine management of conditions [1]. Accumulated evidence suggests that GP referral letters often lack essential clinical information, for example, 38% of specialists in outpatients reported that referral letters contain inadequate information fairly often or very often [2,3]. Letters may fail to explain clearly why the patient is being referred or what is being asked of the specialist team (diagnosis, investigation, treatment or reassurance) [4]. "
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    ABSTRACT: Referral management centres (RMC) for elective referrals are designed to facilitate the primary to secondary care referral path, by improving quality of referrals and easing pressures on finite secondary care services, without inadvertently compromising patient care.This study aimed to evaluate whether the introduction of a RMC which includes triage and feedback improved the quality of elective outpatient referral letters. Retrospective, time-series, cross-sectional review involving 47 general practices in one primary care trust (PCT) in South-East England. Comparison of a random sample of referral letters at baseline (n = 301) and after seven months of referral management (n = 280). Letters were assessed for inclusion of four core pieces of information which are used locally to monitor referral quality (blood pressure, body mass index, past medical history, medication history) and against research-based quality criteria for referral letters (provision of clinical information and clarity of reason for referral). Following introduction of the RMC, the proportion of letters containing each of the core items increased compared to baseline. Statistically significant increases in the recording of 'past medical history' (from 71% to 84%, p < 0.001) and 'medication history' (78% to 87%, p = 0.006) were observed. Forty four percent of letters met the research-based quality criteria at baseline but there was no significant change in quality of referral letters judged on these criteria across the two time periods. Introduction of RMC has improved the inclusion of past medical history and medication history in referral letters, but not other measures of quality. In approximately half of letters there remains room for further improvement.
    Full-text · Article · Aug 2013 · BMC Health Services Research
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    • "collaboration aspects such as referral (Bowling and Redfern, 2000); and . correspondence (Garasen and Johnsen, 2007; Glintborg et al., 2007). "
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    ABSTRACT: This paper aims to assess the validity of a questionnaire aimed at assessing how general practitioners (GPs) and specialists rate collaboration. Primary data were collected in The Netherlands during March to September 2006. A cross-sectional study was conducted among 259 GPs and 232 specialists. Participants were randomly selected from The Netherlands Medical Address Book. Specialists rarely contacting a GP were not invited to participate. Exploratory factor analysis indicated that the questionnaire, consisting of 20 items, measured five domains: organisation; communication; professional expertise; image; and knowing each other. Cronbach's alpha coefficients ranged from 0.64 to 0.83 indicating sufficient internal consistency. Correlation coefficients between domains were all < 0.4. All but "communication" clearly produced distinguishing scores for different respondent groups. This study shows that the doctors' opinions on collaboration (DOC) questionnaire is valid and that it may have the potential to give feedback to both medical professionals and policy makers. Such feedback creates an opportunity to improve collaboration. The DOC questionnaire is a useful instrument for assessing collaboration among GPs and specialists. It can provide feedback to both medical professionals and policy makers. Such feedback creates an opportunity to improve collaboration.
    Full-text · Article · Jun 2010 · International Journal of Health Care Quality Assurance
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    • "collaboration aspects such as referral (Bowling and Redfern, 2000); and . correspondence (Garasen and Johnsen, 2007; Glintborg et al., 2007). "

    Full-text · Article · Jan 2010
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