Exploring implementation of an electronic referral management system and enhanced primary care service for oral surgery: perspectives of patients, providers and practitioners

Abstract

BackgroundA specialist primary care oral surgery service combined with an electronic referral management and triage system was developed in response to concerns raised around overburdened secondary care services in the UK. Whilst the system has the potential to manage conflicting demand for oral surgery services against an objective need, the new pathway represents a number of challenges to existing working practices and could compromise the sustainability of existing hospital services. The aim of this research was to carry out a qualitative exploration of implementation of a new intervention to gain insight into how these challenges have manifested and been addressed.MethodsViews were sought from stakeholders (dentists, hospital staff, commissioners and patients) at various time points over 3 years during and after implementation using semi-structured interviews. Normalization Process Theory informed a qualitative thematic analysis which was carried out using data from interview transcripts to identify important emerging issues.ResultsThemes emerging from the data were; amenability to change and assimilation into practice (primary care dentists), compliance and governance, changing perceptions of impact (secondary care staff and commissioners) understanding change in service provision and priorities for treatment (patients). The new pathway impacted stakeholders at different stages of implementation.ConclusionElectronic referral management with a primary care advanced service for oral surgery was successfully implemented in a specific area of the UK. The service model evaluated has the potential to be expanded across a wider geographical footprint and to support demand management in other specialist services.

Can patients make heads or tails of enhanced primary health care (EnPHC)? Experience through their own journey

“…From the findings, patients also perceived services are more accessible after implementation of EnPHC which in accordance to study demonstrated by Goldthorpe [ 29 ] where patients are in favour of appointments and treatments at clinics near to them. The paper also discussed a lot of interpersonal skills of HCPs as in line with the study findings - proficient communication is vital for patients to have the urge to make an effort for self-monitoring and be engaged in overcoming their own NCD issues.…”

The impact of National Health Insurance online referral system on the access and quality of health services in Gianyar District, Bali, Indonesia

“…10,22,23,29 Furthermore, there is a decrease in the workload of officers, especially due to reduced recording and filling time, and assurance that the referral reach RCHS without any need to do any confirmatory calls. [20][21][22] In terms of the quality of patient's data recording, the results of the study showed an increase in the quality of referral data recording. This result is in accordance with several studies which state that referrals using an online registration system provide a sense of security to patients because they do not need to worry about referral letters being scattered, lost or damaged.…”

“…18, 19 Increasing information disclosure regarding service time, type of service, resources owned by the health facilities in the BPJS Kesehatan online referral system has an impact on the ease of PHCS and patients to obtain information about the services available at the RHCS. 10, 20 Accurate information about the type of specialist services and service schedules at RHCS greatly helps patients to obtain health services more quickly and precisely in accordance with the patient's medical needs. 10,21, 22 The online referral system also provides certainty in scheduling visits to specialists at the referral hospital which allows patients to meet specialists directly according to the agreed schedule.…”

“…10,23, 24 Patients with specific health service requirements and special conditions such as haemodialysis, thalassemia, haemophilia, psychiatric disorders, leprosy, MDR-TB, chemotherapy, radiotherapy, HIV-PLHIV are able to be more easily acquire appropriate treatment according to the their medical condition. 20,25 Improved communication between services on the online referral system also facilitates the transfer of information (knowledge sharing) between health professionals. 21,26, 27 Another positive impact is the ease of administration arrangements for patients and service providers.…”

An eReferral Management & Triage System for minor Oral surgery referrals from primary care dentists: a cost-effectiveness evaluation

“…The analysis showed that a majority of patients (87%) that were redirected to have surgery at a primary care specialist service attended their appointment. A nested qualitative study found that patients’ priorities were largely indifferent to how services were organised and the location they were ultimately treated under [ 12 ].…”