A categorisation of problems and solutions to improve patient referrals from primary to specialty care

Abstract

BackgroundImproving access to specialty care has been identified as a critical issue in the delivery of health services, especially given an increasing burden of chronic disease. Identifying and addressing problems that impact access to specialty care for patients referred to speciality care for non-emergent procedures and how these deficiencies can be managed via health system delivery interventions is important to improve care for patients with chronic conditions. However, the primary-specialty care interface is complex and may be impacted by a variety of potential health services delivery deficiencies; with an equal range of interventions developed to correct them. Consequently, the literature is also diverse and difficult to navigate. We present a narrative review to identify existing literature, and provide a conceptual map that categorizes problems at the primary-specialty care interface with linkages to corresponding interventions aimed at ensuring that patient transitions across the primary-specialty care interface are necessary, appropriate, timely and well communicated.MethodsWe searched MEDLINE and EMBASE databases from January 1, 2005 until Dec 31, 2014, grey literature and reference lists to identify articles that report on interventions implemented to improve the primary-specialty care interface. Selected articles were categorized to describe: 1) the intervention context, including the deficiency addressed, and the objective of the intervention 2) intervention activities, and 3) intervention outcomes.ResultsWe identified 106 articles, producing four categories of health services delivery deficiencies based in: 1) clinical decision making; 2) information management; 3) the system level management of patient flows between primary and secondary care; and 4) quality-of-care monitoring. Interventions were divided into seven categories and fourteen sub-categories based on the deficiencies addressed and the intervention strategies used. Potential synergies and trade-offs among interventions are discussed. Little evidence exists regarding the synergistic and antagonistic interactions of alternative intervention strategies.ConclusionThe categorization acts as an aid in identifying why the primary-specialty care interface may be failing and which interventions may produce improvements. Overlap and interconnectedness between interventions creates potential synergies and conflicts among co-implemented interventions.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3745-y) contains supplementary material, which is available to authorized users.

The voice of patients in system redesign: A case study of redesigning a centralized system for intake of referrals from primary care to rheumatologists for patients with suspected rheumatoid arthritis

“…A set of candidate strategies for optimization of CI was identified during a 1‐day stakeholder meeting. Participants (patients and PaCERs [n = 2], health‐care professionals [n = 10], health‐care administrators [n = 7] and academic researchers [n = 9]) were presented with the elements of predefined based on the literature and discussions with relevant stakeholders candidate strategies for CI. Afterwards, participants reflected on proposed models and provided feedback to develop the preferred model for Alberta.…”

Knowledge, Attitude, And Perception of Oral and Maxillofacial Surgery Specialty Amongst Healthcare Professionals, and the General Public from a Gulf Cooperation Council (GCC) Country

“…Proper referral systems ultimately lead to better patient care delivery, smaller burdens on hospital services, and greater patient satisfaction. [12,13] Undoubtedly, OMFS surgeons will most likely continue to gather knowledge and clinical skills depending on case exposure to over time.…”

“…Although such unrestricted access has bene ts (such as fast patient ow), they are countered by possibly inappropriate self-referrals. [13] The latter causes higher patient costs in addition to increased risk of management by health care providers not entirely skilled in a given case. [13] Our ndings indicate that most medical and dental clinicians will refer to OMFS for jaw fractures, orbital fractures, and dental trauma instead of ENT, GS, or PS, which is consistent with Rocha et al's ndings.…”

“…[13] The latter causes higher patient costs in addition to increased risk of management by health care providers not entirely skilled in a given case. [13] Our ndings indicate that most medical and dental clinicians will refer to OMFS for jaw fractures, orbital fractures, and dental trauma instead of ENT, GS, or PS, which is consistent with Rocha et al's ndings. [9] The orbital fracture ndings contradict Haron et al's 2013 study, which stated medical doctors were less likely to refer to OMFS.…”

Integrating Germline Genetics Into Precision Oncology Practice in the Veterans Health Administration: Challenges and Opportunities

“…In addition, avoiding referral outside of the VA could help to ensure continuity of care, more efficient care, and reduce the risk of duplication of testing, and polypharmacy. [34][35][36][37] As part of its precision oncology initiative, VA is focusing on building clinical genetics services capacity. To increase access to clinical genetic services and appropriate genetic testing, the VA needs more genetics professionals, including clinical geneticists, genetic counselors, and genetic nurses-ideally a workforce study could be performed to inform the right staffing mix needed.…”