Patient and practice characteristics predict the frequency of general practice multidisciplinary referrals of patients with chronic diseases: A multilevel study

Harris, Mark; Jayasinghe, Upali W; Chan, Bibiana; Proudfoot, Judy; Crookes, Patrick A; Zwar, Nicholas; Davies, Gawaine Powell

doi:10.1016/j.healthpol.2010.10.019

Cited by 9 publications

(17 citation statements)

References 15 publications

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“…210,[263][264][265][266][267][268]270 A further two lower-risk studies showed no association between these factors. 138,269 Overall, the strength of evidence was graded as weaker.…”

Section: Service Usementioning

confidence: 99%

“…Albertson et al 157 found that patients were significantly more likely to have initiated the referral discussion when they had seen the GP previously; there was a trend for patient initiation of the referral discussion when the patient had known the GP for more than 1 year (p = 0.08) Cohen et al 267 reported that a greater number of GP visits was related to a lower hazard ratio for referral and more days to referral. Harris et al 268 found that previous referral was associated with the likelihood of subsequent referral. However, in contrast to these papers reporting an association, Pfeiffer et al 138 found that attendance at a primary care service for mental health was not a predictor of total number of specialist mental health clinic visits; and Vinker et al 269 found that the length of time the patient was with the GP did not affect referral.…”

Section: Service Usementioning

confidence: 99%

“…108,161,164,174,176,177,181,186,195,200,201,214,218,[222][223][224][225][226][227][228][229][230][231][232][233][234][235][236][237][238][239]258,274,[292][293][294] Six of these studies 186,214,224,227,233,236 were considered at higher risk of bias. Only two studies reported no association 268,275 and so this evidence was graded as stronger. …”

Section: General Practitioner Factorsmentioning

confidence: 99%

“…Twenty-five studies showed an association between age and referral rate, of which 14 studies reported higher rates of referral for older patients 164,166,181,188,212,263,264,267,268,275,281,[283][284][285] and six studies reporting higher rates of referral for younger patients. 234,278,[286][287][288]295 Chan et al 275 also reported that children were referred more often than adults and Vinker et al 269 reported more urgent referral for younger patients.…”

Section: Patient Factorsmentioning

confidence: 99%

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What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis

Blank

Baxter

Woods

et al. 2015

Health Services and Delivery Research

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BackgroundDemand management describes any method used to monitor, direct or regulate patient referrals. Several strategies have been developed to manage the referral of patients to secondary care, with interventions targeting primary care, specialist services, or infrastructure.ObjectiveThis research aimed to conduct an inclusive systematic review and logic model synthesis in order to better understand factors impacting on the effectiveness of interventions targeting referral between primary and secondary medical health care.DesignThe approach combined systematic review with logic modelling synthesis techniques to develop an evidence-based framework of factors influencing the pathway between interventions and system-wide changes.SettingPrimary health care.Main outcome measuresReferral from primary to secondary care.Review methodsSystematic searches were undertaken to identify recent, relevant studies. Quality of individual studies was appraised, with consideration of overall strength of evidence. A narrative synthesis and logic model summary of the data was completed.ResultsFrom a database of 8327 unique papers, 290 were included in the review. The intervention studies were grouped into four categories of education interventions (n = 50); process change interventions (n = 49); system change interventions (n = 38); and patient-focused interventions (n = 3). Effectiveness was assessed variously in these papers; however, there was a gap regarding the mechanisms whereby these interventions lead to demand management impacts. The findings suggest that, although individual-level interventions may be popular, the stronger evidence relates only to peer-review and feedback interventions. Process change interventions appeared to be more effective when the change resulted in the specialist being provided with more or better quality information about the patient. System changes including the community provision of specialist services by general practitioners, outreach provision by specialists and the return of inappropriate referrals appeared to have evidence of effect. The pathway whereby interventions might lead to service-wide impact was complex, with multiple factors potentially acting as barriers or facilitators to the change process. Factors related, first, to the doctor (including knowledge, attitudes and beliefs, and previous experiences of a service), second, to the patient (including condition and social factors) and, third, to the influence of the doctor–patient relationship. We also identified a number of potentially influential factors at a local level, such as perceived waiting times and the availability of a specialist. These elements are key factors in the pathway between an intervention and intended demand management outcomes influencing both applicability and effectiveness.ConclusionsThe findings highlight the complexity of the referral process and multiple elements that will impact on intervention outcomes and applicability to a local area. Any interventions seeking to change referral practice need to address factors relating to the individual practitioner, the patient and also the situation in which the referral is taking place. These conclusions apply especially to referral management in a UK context where this whole range of factors/issues lies well within the remit of the NHS. This work highlights that intermediate outcomes are important in the referral pathway. It is recommended that researchers include measure of these intermediate outcomes in their evaluation of intervention effectiveness in order to determine where blocks to or facilitators of system-wide impact may be occurring.Study registrationThe study is registered as PROSPERO CRD42013004037.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…210,[263][264][265][266][267][268]270 A further two lower-risk studies showed no association between these factors. 138,269 Overall, the strength of evidence was graded as weaker.…”

Section: Service Usementioning

confidence: 99%

Section: Service Usementioning

confidence: 99%

Section: General Practitioner Factorsmentioning

confidence: 99%

Section: Patient Factorsmentioning

confidence: 99%

See 2 more Smart Citations

What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis

Blank

Baxter

Woods

et al. 2015

Health Services and Delivery Research

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show abstract

“…Primary health care provides the means of organising a complete range of care, from home to hospital, investing resources rationally in the different levels of health. NCDs require an integrated care model using multidisciplinary and teamwork approaches in which primary care is on the front line in order to provide optimal care on a basis of adequate public health strategies [64,65].…”

Section: Integrated Care Model For the Control Of Ncdsmentioning

confidence: 99%

Systems Medicine Approaches for the Definition of Complex Phenotypes in Chronic Diseases and Ageing. From Concept to Implementation and Policies

Bousquet¹,

Jørgensen²,

Dauzat³

et al. 2014

CPD

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Disease management in diabetes care: When involving GPs improves patient compliance and health outcomes

Ugolini¹,

Bruni²,

Leucci³

et al. 2019

Health Policy

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Although the study of the association between interventions in primary care and health outcomes continues to produce mixed findings, programs designed to promote the greater compliance of General Practitioners and their diabetic patients with treatment guidelines have been increasingly introduced worldwide, in an attempt to achieve better quality diabetes care through the enhanced standardisation of patient supervision. In this study we use clinical data taken from the Diabetes Register of one Local Health Authority (LHAs) in Italy's Emilia-Romagna Region for the period 2014-2015. Firstly, we test to see whether the monitoring activities prescribed for diabetics by regional diabetes guidelines, actually have a positive impact on patients' health outcomes and increase appropriateness in health care utilization. Secondly, we investigate whether GPs' participation in the local Diabetes Management Program (DMP) leads to improved patient compliance with regional guidelines. Our results show that such a program, which aims to increase GPs' involvement and cooperation in following regional guidelines for best practices, achieves its goal of improved patient compliance with the prescribed actions. In turn, through the implementation of the DMP and the greater involvement of physicians, regional policies have succeeded in promoting better health outcomes and the improved appropriateness of health care utilization.

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Patient and practice characteristics predict the frequency of general practice multidisciplinary referrals of patients with chronic diseases: A multilevel study

Cited by 9 publications

References 15 publications

What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis

What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis

Systems Medicine Approaches for the Definition of Complex Phenotypes in Chronic Diseases and Ageing. From Concept to Implementation and Policies

Disease management in diabetes care: When involving GPs improves patient compliance and health outcomes

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