Failure to improve appropriateness of referrals to adult community mental health services--lessons from a multi-site cluster randomized controlled trial

Abstract

Asking GPs to complete a TAG when referring to CMHTs did not improve primary-secondary care agreement on referrals. Low implementation means that uncertainty remains about whether introducing a severity-focussed measure into the referral process is beneficial. Introducing local protocols to manage demand at this interface may not be successful and more attention needs to be paid to human and organizational factors in managing interfaces between services.

Mixed Method Designs in Implementation Research

“…In 17 studies, the qualitative study was embedded within a larger quantitative effectiveness trial or implementation study. Slade et al (2008) nested a qualitative study within a multi-site randomized controlled trial of a standardized assessment of mental health problem severity to determine whether the intervention improved agreement on referrals and to identify professional and organizational barriers to implementation. In 11 studies, the insights gained from one type of method were connected to a different type of method to answer related questions through complementarity, expansion, development or sampling.…”

Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research

“…In one study (Goia & Dziadosz, 2008), criterion sampling was used in a simultaneous design where quantitative and qualitative data were merged together in a complementary fashion, and in two studies (Aarons et al, 2012; Zazelli et al, 2008), quantitative and qualitative data were connected together, one in sequential design for the purpose of developing a conceptual model (Zazelli et al, 2008), and one in a simultaneous design for the purpose of complementing one another (Aarons et al, 2012). Three of the six studies that used maximum variation sampling used a simultaneous structure with quantitative methods taking priority over qualitative methods and a process of embedding the qualitative methods in a larger quantitative study (Henke et al, 2008; Palinkas et al, 2010; Slade et al, 2008). Two of the six studies used maximum variation sampling in a sequential design (Aarons et al, 2009; Zazelli et al, 2008) and one in a simultaneous design (Henke et al, 2010) for the purpose of development, and three used it in a simultaneous design for complementarity (Bachman et al, 2009; Henke et al, 2008; Palinkas, Ell, Hansen, Cabassa, & Wells, 2011).…”

Referral interventions from primary to specialist care: a systematic review of international evidence

“…Process changes were defined as smallscale changes to some aspect of the individual referral process that did not involve the movement of staff or relocation of clinics, the methods in which referrals were triaged at hospital, or financial arrangements for referral. Process change interventions included: designated appointment slots and fast-track clinics for primary care referrals (n = 6), [60][61][62][63][64][65] direct access to screening (n = 9), 66 to referral (individual contact between a specialist and GP) (n = 11), [75][76][77][78][79][80][81][82][83][84][85] electronic referral systems (n = 10), [86][87][88][89][90][91][92][93][94][95] decision support tools (n = 10), [96][97][98][99][100][101][102][103][104][105] and waiting list review or watchful waiting (n = 3). [106][107][108] The overall picture for interventions that aim to moderate referral outcomes by changing an element of the referral process is mixed.…”