Patient's need for choice and information across the interface between primary and secondary care: A survey

Berendsen, Annette J.; Jong, G. Majella de; Schuling, Jan; Bosveld, Henk E. P.; Waal, Margot W. M. de; Mitchell, G.; Meer, Klaas van der; Jong, Betty Meyboom-de

doi:10.1016/j.pec.2009.07.032

Cited by 23 publications

(16 citation statements)

References 20 publications

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“…164,262,271 Two studies reported an association between being more educated and being more likely to be referred. 164,262 and one study reported no association.…”

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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“…164,262,271 Two studies reported an association between being more educated and being more likely to be referred. 164,262 and one study reported no association.…”

Section: Patient Factorsmentioning

confidence: 99%

“…164,262,271 Two studies reported an association between being more educated and being more likely to be referred. 164,262 and one study reported no association. 271 The third of these studies 271 was at higher risk of bias and the evidence was graded as conflicting.…”

Section: Patient Factorsmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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“…Recent research has highlighted a number of areas which are key to understanding effective risk communication, such as the nature and quality of information provided to patients and health-care workers (20), patients’ and the general public’s perceived information needs (21, 22), and role of the media (23). However, little research has been carried out into the impact of institutional arrangements on specific communication strategies (24).…”

Section: Introductionmentioning

confidence: 99%

Communicating the Risk of MRSA: The Role of Clinical Practice, Regulation and Other Policies in Five European Countries

Dickmann

Keeping

Döring

et al. 2017

Front. Public Health

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BackgroundThe threat posed by Meticillin-resistant Staphylococcus aureus (MRSA) has taken on an increasingly pan-European dimension. This article aims to provide an overview of the different approaches to the control of MRSA adopted in five European countries (Austria, Germany, Netherlands, Spain, and the UK) and discusses data and reporting mechanisms, regulations, guidelines, and health policy approaches with a focus on risk communication. Our hypothesis is that current infection control practices in different European countries are implicit messages that contribute to the health-related risk communication and subsequently to the public perception of risk posed by MRSA. A reporting template was used to systematically collect information from each country.DiscussionLarge variation in approaches was observed between countries. However, there were a number of consistent themes relevant to the communication of key information regarding MRSA, including misleading messages, inconsistencies in content and application of published guidelines, and frictions between the official communication and their adoption on provider level.SummaryThe variability of recommendations within, and across, countries could be contributing to the perception of inconsistency. Having inconsistent guidelines and practices in place may also be affecting the level at which recommended behaviors are adopted. The discrepancy between the official, explicit health messages around MRSA and the implicit messages stemming from the performance of infection control measures should, therefore, be a key target for those wishing to improve risk communication.

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“…The health care sector is one of the public sector areas where the introduction of governance -tools has been very important in countries following the Beveridge-model, like England [19], Denmark and Sweden [20], and to a lesser degree in some countries with health care organized in accordance with the Bismarck-model, like France, Germany and the Netherlands [21,22]. …”

Section: Introductionmentioning

confidence: 99%

Patients' experience of choosing an outpatient clinic in one county in Denmark: results of a patient survey

Birk

Gut

Henriksen

2011

BMC Health Serv Res

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BackgroundResearch on patients' choice of hospital has focused on inpatients' rather than outpatients' choice of provider. We have investigated Danish outpatients' awareness and utilisation of freedom of choice of provider; which factors influence outpatients' choice of hospital, and how socio-demographic variables influence these factors in a single uptake area, where patients were free to choose any public hospital, where care was provided free at the point of delivery, and where distance to the closest hospitals were short by international standards.MethodsRetrospective questionnaire study of 4,232 outpatients referred to examination, treatment, or follow-up at one of nine somatic outpatient clinics in Roskilde County in two months of 2002, who had not been hospitalised within the latest 12 months. The patients were asked, whether they were aware of and utilised freedom of choice of hospital.ResultsFifty-four percent (2,272 patients) filled in and returned the questionnaire. Forty-one percent of respondents were aware of their right to choose, and 53% of those patients utilised their right to choose. Awareness of freedom of choice of provider was reported to be especially high in female outpatients, patients with longer education, salaried employees in the public sector, and in patients referred to surgical specialties. Female outpatients and students were especially likely to report that they utilised their right to choose the provider. Short distance was the most important reason for outpatients' choice, followed by the GP's recommendations, short waiting time, and the patient's previous experience with the hospital.ConclusionsOutpatients' awareness and utilisation of free choice of health care provider was low. Awareness of freedom of choice of provider differed significantly by specialty and patient's gender, education and employment. Female patients and students were especially likely to choose the clinic by themselves. Most outpatients chose the clinic closest to their home, the GP's recommendation and short waiting time being the second and third most important factors behind choice.

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Patient's need for choice and information across the interface between primary and secondary care: A survey

Abstract: Care providers should take differences into account concerning patients' need for information on their illness.

Cited by 23 publications

References 20 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

Communicating the Risk of MRSA: The Role of Clinical Practice, Regulation and Other Policies in Five European Countries

Patients' experience of choosing an outpatient clinic in one county in Denmark: results of a patient survey

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