Impact of referral templates on patient experience of the referral and care process: a cluster randomised trial

Abstract

ObjectivesTo evaluate if a referral intervention improves the patient experience of the referral and treatment process.SettingInterface between 14 primary care surgeries and a district general hospital.ParticipantsThe 14 general practitioner (GP) surgeries (7 intervention, 7 control) in the area around the University Hospital of North Norway Harstad were randomised and all completed the study. Consecutive individual patients were recruited at their hospital appointment. A total of 500 patients were recruited with 281 in the intervention and 219 in the control arm.InterventionsDissemination of referral templates for 4 diagnostic groups (dyspepsia, suspected colorectal cancer, chest pain and chronic obstructive pulmonary disease) coupled with intermittent surgery visits by study personnel. The control arm continued standard referral practice. The intervention was in use for 2.5 years.OutcomeThe main outcome was a quality indicator score. This paper reports a secondary outcome, the patient experience, as measured by self-report questionnaires. GPs in the intervention group could not be blinded. Patients were blinded to intervention status. Analysis was based on single-question comparison with a questionnaire subscore used to assess the effect of clustering.ResultsOn the individual questions, overall satisfaction was very high with minor differences between the intervention and control group. Interestingly, the most negative responses, in both groups concerned questions relating to patient interaction and information. Very little evidence of clustering was found with an estimated intracluster correlations coefficient at 1.21e−11.ConclusionsIn total, this indicates no clear effect of the implementation of referral templates on the patient experience, in a setting of generally high patient satisfaction.Trial registration numberNCT01470963; Results.

Improving quality of referral letters from primary to secondary care: a literature review and discussion paper

“…Second, adherence to the referral template may be variable depending on workload and time constraints. A second analysis published one year later (Wahlberg et al ., 2016) investigated the impact on patient experience of the care process using self-report questionnaires and found no significant improvement in patient experience. This paper had a high response rate (82%) but the use of a short-form questionnaire limited the depth of data that was collected.…”

“…Studies varied in methodologies: 12 studies were quantitative, four were qualitative and two studies used a mixed methods approach. Study limitations included having a small sample size (Jiwa and Dhaliwal, 2012; Corwin and Bolter, 2014), and being limited to a single region or health service network (Shaw and de Berker, 2007; Evans, 2009; Hysong et al ., 2011; Rokstad et al ., 2013; Wahlberg et al ., 2015; 2016; 2017; Zuchowski et al ., 2015; Nash et al ., 2016), and consequently, the findings may not be generalisable and relevant to other health systems. Some of the studies involved only PCPs as participants, whereas the involvement of specialists would have been useful for triangulation (Xiang et al ., 2013; Eskeland et al ., 2017).…”

“…Evans (2009) 4 Improvement in referral quality and reducing inappropriate demand Xiang et al (2013) 3 Improvement in referral quality and decisions made will be more accurate Elwyn et al (2007) 3 Improving the quality of referrals and reducing demand Templates Haley et al (2015) 3 Improvement in documentation Rokstad et al (2013) 4 Improvement in referral quality and in time efficiency by the specialist reviewing the letters Wahlberg et al (2015) 3 Improvement in documentation Wahlberg et al (2016) 3 Sought to prove association with patient experience compared with control but none seen Wahlberg et al (2017) 3 Sought to prove association with improved quality of care through quality indicators but none seen Eskeland et al (2017) 3 Improvement in referral quality Jiwa et al (2014) 3 Improvement in documentation of clinically relevant data. Referral times unchanged.…”

“…A study of referrals using templates from nine primary care practices to nephrology clinics Kim et al (2009) 4 72% believed that ERs improved overall clinical care of patients but the study population was a mixture of physicians, many were specialists and the study setting is not representative of typical general practice Nash et al (2016) 3 ERs provided more clinical information than handwritten but no effect on patient or system outcomes Hysong et al 2011NA Improvement in referral coordination by PCPs and subspecialists Zuchowski et al (2015) NA Improvement in referral communication Peer feedback Evans (2009) 4 Improvement in referral quality and reducing inappropriate demand Xiang et al (2013) 3 Improvement in referral quality and decisions made will be more accurate Elwyn et al (2007) 3 Improving the quality of referrals and reducing demand Templates Haley et al 20153 Improvement in documentation Rokstad et al (2013) 4 Improvement in referral quality and in time efficiency by the specialist reviewing the letters Wahlberg et al (2015) 3 Improvement in documentation Wahlberg et al (2016) 3 Sought to prove association with patient experience compared with control but none seen Wahlberg et al (2017) 3 Sought to prove association with improved quality of care through quality indicators but none seen Eskeland et al (2017) 3 Improvement in referral quality Jiwa et al (2014) 3 Improvement in documentation of clinically relevant data. Referral times unchanged.…”

Elementos facilitadores ou dificultadores do processo de Transição do Cuidado: uma revisão integrativa

“…Essas informações são fundamentais para que seja implantado um cuidado integral, porém, o que se observa em alguns estudos é que nem sempre as informações são fornecidas aos demais serviços para garantir a continuidade da assistência (Wahlberg et al, 2016). Para que as informações sejam levantadas em tempo hábil, é importante que se faça melhorias nos materiais educacionais e que seja aumentada a coordenação da equipe assistencial, com um melhor engajamento e compreensão do usuário e cuidador.…”