Referral

Background: around the world health systems constantly face increasing pressures which arise from many factors, such as an ageing population, patients and providers demands for equipment’s and services. In order to respond these challenges and reduction of health system’s transactional costs, referral solutions are considered as a key factor. This study was carried out to identify referral solutions that have had successes. Methods:

The Projahnmo-II Project in Mirzapur upazila (sub-district), Tangail district, Bangladesh, is promoting care-seeking for sick newborns through health education of families, identification and referral of sick newborns in the community by community health workers (CHWs), and strengthening of neonatal care in Kumudini Hospital, Mirzapur. Data were drawn from records maintained by the CHWs, referral hospital registers, a baseline household survey of recently-delivered women conducted from March to June 2003, and two interim household surveys in January and September 2005. Increases were observed in self-referral of sick newborns for care, compliance after referral by the CHWs, and care-seeking from qualified providers and from the Kumudini Hospital, and decreases were observed in care-seeking from unqualified providers in the intervention arm. An active surveillance for illness by the CHWs in the home, education of families by them on recognition of danger signs and counselling to seek...

Despite the increasing usage and popularity of chiropractic care, there has been limited research conducted to examine the professional relationships between conventional trained primary care physicians (PCPs) and chiropractors (DCs). The objectives of our study were to contrast the intra-professional referral patterns among PCPs with referral patterns to DCs, and to identify predictors of PCP referral to DCs. We mailed a survey instrument to all practicing PCPs in the state of Iowa. Descriptive statistics were used to summarize their responses. Multivariable logistic regression analyses were conducted to identify demographic factors associated with inter-professional referral behaviors. A total of 517 PCPs (33%) participated in the study. PCPs enjoyed strong intra-professional referral relationships with other PCPs. Although patients exhibited a great deal of interest in chiropractic care, PCPs were unlikely themselves to make formal referral relationships with DCs. PCPs in a priva...

Objective. To determine how well the current fluoride supplementation schedule was known by academic pediatricians and to examine the fluoride supplement prescribing and dental referral practices among primary care faculty pediatricians at four medical centers. Setting. Four university medical centers in North Carolina. Subjects. Primary care faculty pediatricians. Method. A questionnaire pretested for clarity was distributed to all identified full-time primary care pediatric faculty (42 members). Results. A total of 40 completed questionnaires were returned. Thirty-seven (93%) primary care faculty pediatricians reported that they routinely addressed the need for fluoride supplements for their patients, but only 28 (70%) determined the fluoride content of the drinking water before prescribing supplements. Thirty-five (87.5%) began supplements at the correct age, but fewer knew the correct doses for children of various ages. Only 23 (58%) referred their patients for oral examination ...

As funding for home-based palliative care continues to expand, there is an increasing need to understand barriers to patient referral to and acceptance of home-based palliative care. The aim of this study was to elicit perspectives of home-based palliative care administrators and providers on barriers encountered in identification, referral, and enrollment of patients eligible for home-based palliative care. We conducted a qualitative study employing focus groups of nine home-based palliative care agencies across California. Focus groups were audio-recorded and transcribed. Using thematic analysis, researchers independently coded the transcripts and identified themes from the codes. 25 HBPC staff participated in the nine focus groups. Participants included both clinicians (n=17) and administrators (n=8). Our analysis revealed 13 themes that fit under four major thematic categories: 1) lack of formal payment structures (few HBPC payors and variation in payment and services among payors), 2) agency structure barriers (limitations of electronic medical records and multiple lines of business), 3) patient- and family-level barriers (misconceptions/lack of palliative care knowledge, uninformed of the referral/ no warm hand-off, reluctance to have strangers in the home, overwhelmed with health issues and related services, HBPC service refusal/unresponsive to outreach), and 4) physician-level barriers (misconceptions/lack of palliative care knowledge, variability in HBPC payment and services, lack of time, patient ownership). HBPC providers identified a myriad of barriers that preclude patient access to HBPC. With growing provision of HBPC services, greater efforts to overcome these barriers are needed.

Introduction. Smoking cessation integration within lung cancer screening programs is challenging. Currently, phone counselling is available across Canada for individuals referred by healthcare workers and by self-referral. We compared quit rates after phone counselling interventions between participants who self-refer, those referred by healthcare workers, and those referred by a lung cancer screening program. Methods. This is a retrospective cohort study of participants referred to provincial smoking cessation quit line in contemporaneous cohorts: self-referred participants, healthcare worker referred, and those referred by a lung cancer screening program if they were still actively smoking at the time of first contact. Baseline, covariates (sociodemographic information, smoking history, and history of mental health disorder) and quit intentions (stage of change, readiness for change, previous use of quit programs, and previous quit attempts) were compared among the three cohorts. ...

As funding for home-based palliative care continues to expand, there is an increasing need to understand barriers to patient referral to and acceptance of home-based palliative care. The aim of this study was to elicit perspectives of home-based palliative care administrators and providers on barriers encountered in identification, referral, and enrollment of patients eligible for home-based palliative care. We conducted a qualitative study employing focus groups of nine home-based palliative care agencies across California. Focus groups were audio-recorded and transcribed. Using thematic analysis, researchers independently coded the transcripts and identified themes from the codes. 25 HBPC staff participated in the nine focus groups. Participants included both clinicians (n=17) and administrators (n=8). Our analysis revealed 13 themes that fit under four major thematic categories: 1) lack of formal payment structures (few HBPC payors and variation in payment and services among payors), 2) agency structure barriers (limitations of electronic medical records and multiple lines of business), 3) patient- and family-level barriers (misconceptions/lack of palliative care knowledge, uninformed of the referral/ no warm hand-off, reluctance to have strangers in the home, overwhelmed with health issues and related services, HBPC service refusal/unresponsive to outreach), and 4) physician-level barriers (misconceptions/lack of palliative care knowledge, variability in HBPC payment and services, lack of time, patient ownership). HBPC providers identified a myriad of barriers that preclude patient access to HBPC. With growing provision of HBPC services, greater efforts to overcome these barriers are needed.

Arts for health interventions are an accepted option for medical management of mental wellbeing in health care. Updated findings are presented from a prospective longitudinal follow-up (observational) design study of an arts on referral programme in UK general practice, over a 7-year period (2009-2016). Primary care process and mental wellbeing outcomes were investigated, including progress through the intervention, changes in mental wellbeing, and factors associated with those outcomes. A total of n = 1297 patients were referred to an eight or 10-week intervention over a period from 2009 to 2016. Patient sociodemographic information was recorded at baseline, and patient progress (e.g. attendance) assessed throughout the intervention. Of all referrals, 51.7% completed their course of prescribed art (the intervention). Of those that attended, 74.7% engaged with the intervention as rated by the artists leading the courses. A significant increase in wellbeing was observed from pre- to ...

Introduction : The Partograph is a tool that monitors active stages of labour. This enables skilled birth attendants, who are largely midwives, to monitor progress of labour, the mother and the fetus regularly. It provides a clear means of tracking labour progress with ‘alert’ and ‘action’ lines that signal when labour has become complicated. It helps in the management of labour by providing information to identify women who are or not likely to have a normal delivery. Objective: To assess partograph utilization among nurse-midwives in the maternity unit of Coast General Hospital, Mombasa. Methods: This was a descriptive study among midwives and nurse-midwives working in the Maternity unit of Coast general hospital, Mombasa. All 59 nurse-midwives who were working in the unit during the study period were included in the study with an eventual response rate of 86% (51). Data was collected using a self-administered semi- structured questionnaire. Qualitative data was cleaned, coded and...

Background Pharmacists can play a key role in managing ailments through their primary roles of supplying over-the-counter (non-prescription) medicines and advice-giving. It must be ensured that pharmacy staff practise in an evidence-based, guideline-compliant manner. To achieve this, mystery shopping can be used as an intervention to assess and train pharmacy staff. Objective To determine if repeated student pharmacist mystery shopping with immediate feedback affected the outcome of scenarios requiring referral to a medical practitioner. To determine what, if any, factors may influence whether referral occurred. Setting Thirteen community pharmacies across metropolitan Sydney, Australia. Methods Sixty-one student pharmacist mystery shoppers visited 13 community pharmacies across metropolitan Sydney once weekly over nine weeks between March-October 2015 to conduct audio-recorded mystery shopping visits with assigned scenarios (asthma, dyspepsia, diarrhoea). Students returned to the p...

This study examined the referral patterns of rural/remote primary care physicians (PCPs) as well as their needs and interests for further training in child/adolescent mental health. Surveys were mailed to Canadian rural/remote PCPs requesting participants' demographic information, training and qualifications, referral patterns, and identification of needs and interests for continuing medical education (CME). PCPs were most likely to refer to mental health programs, and excessive wait times are the most common deterrent. Major reasons for referral were to obtain recommendations regarding medications and assessing non-responsive patients. While PCPs expressed higher levels of confidence in making appropriate referrals, they were much less confident in their knowledge and skills in managing mental health problems. Professional development in child/adolescent psychiatry is a moderate or highly perceived CME need. Overall, attention deficit/hyperactivity disorder (ADHD) was the most ...

Background:  Diabetes is a chronic metabolic disease with increasing prevalence globally. Glycemic control is the ultimate management goal possible through self-care activities predominantly patient-driven and enhanced by one’s knowledge. These consequently minimize associated adverse complications hence maintaining the quality of life among people with diabetes. Self-care knowledge and practice are globally found unsatisfying to control glycemia among many diabetic populations. There is a critical need to assess current knowledge and practice regarding self-care among diabetic people to control their diabetes. Methods:  We conducted a hospital-based cross-sectional study on 228 participants who were living with diabetes for at least six months since diagnosis. A standard tool, adopted and modified to suit the setting was used; the self-report Diabetic Knowledge Test Questionnaire for self-care knowledge and a revised version of the Summary Diabetes Self-Care Activities Questionnair...

Estimating the prevalence of SARS-CoV-2 antibody seropositivity among health care workers (HCWs) is crucial. In this study, the seroprevalence of anti-SARS-CoV-2 antibodies among HCWs of five hospitals of Tehran, Iran with high COVID-19 patient's referrals from April to June, 2020, was assessed. In this cross-sectional study, HCWs from three public and two private hospitals, selected randomly as a pilot, were included. Participants were asked questions on their demographic characteristics, medical history, hospital role, and usage of personal protective equipment (PPE). Iran FDA-approved SARS-CoV-2 ELISA kits were used to detect IgG and IgM antibodies in blood samples. The seroprevalence was estimated on the basis of ELISA test results and adjusted for test performance. Among the 2,065 participants, 1,825 (88.4%) and 240 (11.6%) HCWs were recruited from public and private hospitals, respectively. A total of 340 HCWs were tested positive for SARS-CoV-2-specific IgG or IgM antibod...

Background: Each year 4.2 million people around the world die within 30 days of surgery and postoperative deaths account for 7.7 % of all deaths. So this study aimed to asses’ magnitude of postoperative mortality and associated factors among patients who underwent surgery in Wolaita Sodo University Teaching referral Hospital.Method: Retrospective cross sectional design was carried out from April 15-30 2019. Card review was done on 384 participants by using Systematic sampling technique. Entered to Epi Data; exported to SPSS for analysis. Variables with p-value < 0.25 in bivariate analysis were entered to multivariate logistic regression. Statistical significance is determined at p-value < 0.05.Results: The magnitude of postoperative mortality was 5.7%. Using surgical check list (AOR= 0.18; 95% CI 0.05 to 0.61), having comorbid condition (AOR= 4.45; 95% CI 1.39 to 14.19), and don’t having blood transfusion (AOR= 0.07; 95% CI 0.02 to 0.22) and general anesthesia (AOR= 4.37; 95% ...

Efficacy of GP referral of insufficiently active al activity counseling: self-reported physical activity, sedentary behavior, quality of life, and depression. James et al. BMC Family Practice (2014) 15:218 DOI 10.1186/s12875-014-0218-1Callaghan, NSW, Australia Full list of author information is available at the end of the articleDiscussion: If referral of primary care patients to exercise specialists increases physical activity, this process offers the prospect of systematically and sustainably reaching a large proportion of insufficiently active adults. If shown to be efficacious this trial provides evidence to expand public funding beyond those with a chronic disease and for delivery via telephone as well as face-to-face consultations.

Introduction: Effective planning to improve medical issues via EMS is an essential need.  This study aimed to evaluate the  causes, variety and factors associated with patients' dispatch via Medical Emergencies from different townships of Ilam province to Ilam city or cities from the other provinces and by a practical suggestion helps to improve the emergency cares at the event place.

Materials & methods: By a descriptive study all dispatched patients during March to August 2010 by Ilam province EMS were investigated consecutively. Demographic data and all information about causes and factors related to patients dispatch were collected via a valid questionnaire and finally the data were entered into the SPSS version16 and using descriptive tables and relevant tests were analysed.

 

Findings: Totally 960 cases were referred to Ilam or other provinces during study project among which the highest figure (196 patients (20.4%)) was from Abdanan city and the least figure was from Ilam (59 (6.1%)) and 59% of patients was attributed to  males.  Also, the rates of patients from urban and rural areas were 73.1% and 26.3% respectively and 0.5% was among emigrants and visitors. 48% of referrals (449 patients) were due to accident and others were due to other different diseases and the highest rate of referrals (30.7) had surgical reasons and 22.9% was associated with cardiovascular diseases. In this study, the most patients' referrals (65.3%) were ordered by general medics and destination of 94% of referrals was Ilam city, inside the province. 97.3% of referrals was due to absent of relevant specialist and only 21.3% of referrals were due to emphasis of specialists upon the actual need of patients and the highest rate of referrals were due to lateral and unimportant reasons.

Discussion & conclusions: The most patients' dispatches were due to absence of relevant specialist and the highest rate of referrals had surgical reasons; therefore, employment of specialists particularly surgeon and settlement of diagnostic tools such as sonography, radiology and CT scan can considerably reduce the number of dispatches. Also, the highest number of referrals was ordered by general medics, which reveals lack of enough specialists in Ilam townships and absence of a regular referral system in this province.