Communication between primary care physicians and consultants

Epstein, Ron

doi:10.1001/archfami.4.5.403

Cited by 124 publications

(95 citation statements)

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“…facilitates opportunities for communication , 23 and may help to improve communication. 30 For example, interactive interventions aimed at improving quality of communication between PCPs and specialty providers may have contributed to improved patient outcomes for diabetes and mental illness. 31 This may explain our finding that eConsults, which create a virtual mechanism for these "hallway conversations," were viewed by PCPs as a positive development that is improving communication with specialists.…”

Section: Discussionmentioning

confidence: 99%

Challenges in Referral Communication Between VHA Primary Care and Specialty Care

et al. 2014

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BACKGROUND:Poor communication between primary care providers (PCPs) and specialists is a significant problem and a detriment to effective care coordination. Inconsistency in the quality of primary-specialty communication persists even in environments with integrated delivery systems and electronic medical records (EMRs), such as the Veterans Health Administration (VHA). OBJECTIVE: The purpose of this study was to measure ease of communication and to characterize communication challenges perceived by PCPs and primary care personnel in the VHA, with a particular focus on challenges associated with referral communication. DESIGN:The study utilized a convergent mixed-methods design: online cross-sectional survey measuring PCPreported ease of communication with specialists, and semi-structured interviews characterizing primary-specialty communication challenges. PARTICIPANTS: 191 VHA PCPs from one regional network were surveyed (54 % response rate), and 41 VHA PCPs and primary care staff were interviewed. MAIN MEASURES/APPROACH: PCP-reported ease of communication mean score (survey) and recurring themes in participant descriptions of primary-specialty referral communication (interviews) were analyzed. KEY RESULTS: Among PCPs, ease-of-communication ratings were highest for women's health and mental health (mean score of 2.3 on a scale of 1-3 in both), and lowest for cardiothoracic surgery and neurology (mean scores of 1.3 and 1.6, respectively). Primary care personnel experienced challenges communicating with specialists via the EMR system, including difficulty in communicating special requests for appointments within a certain time frame and frequent rejection of referral requests due to rigid informational requirements. When faced with these challenges, PCPs reported using strategies such as telephone and e-mail contact with specialists with whom they had established relationships, as well as the use of an EMR-based referral innovation called "eConsults" as an alternative to a traditional referral.CONCLUSIONS: Primary-specialty communication is a continuing challenge that varies by specialty and may be associated with the likelihood of an established connection already in place between specialty and primary care. Improvement in EMR systems is needed, with more flexibility for the communication of special requests. Building relationships between PCPs and specialists may also facilitate referral communication.

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Section: Discussionmentioning

confidence: 99%

Challenges in Referral Communication Between VHA Primary Care and Specialty Care

et al. 2014

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“…The content of a referral letter greatly influences the referral process. [40][41][42][43][44] Much of eReferral software "content" was standardized, and allowed the referring provider to choose the specialty, enter a brief reason for referral, and select the urgency of the referral. 45 Studies have shown increased physician satisfaction and better feedback from specialists when referral templates are used to standardize referral communication.…”

Section: Teaching Point 2: Evaluation Must Determine Whether Technolomentioning

confidence: 99%

Implementation Science Workshop: Implementation of an Electronic Referral System in a Large Academic Medical Center

et al. 2015

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“…3,5 Referrals in the outpatient setting are healthcare processes that are susceptible to breakdowns. [6][7][8][9][10][11] Breakdowns in the referral process can result in poor continuity of care, slow the diagnostic process, 6 cause delays to and repetition of diagnostic tests, 7 contribute to polypharmacy, 6 increase litigation risk, cause patient and provider dissatisfaction and promote loss of confidence in providers. Referral breakdowns threaten the quality of care.…”

Section: Introductionmentioning

confidence: 99%

When your words count: a discriminative model to predict approval of referrals

Esquivel¹,

Dunn²,

McLane³

et al. 2009

Journal of Innovation in Health Informatics

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Objective To develop and test a statistical model which correctly predicts the approval of outpatient referrals when reviewed by a specialty service based on nine discriminating variables. Design Retrospective cross-sectional study. Setting Large public county hospital system in a southern US city. Participants Written documents and associated data from 500 random adult referrals made by primary care providers to various specialty services during the course of one month. Main outcome measures The resulting correct prediction rates obtained by the model. Results The model correctly predicted 78.6% of approved referrals using all nine discriminating variables, 75.3% of approved referrals using all variables in a stepwise manner and 74.7% of approved referrals using only the referral total word count as a single discriminating variable. Conclusions Three iterations of the model correctly predicted at least 75% of the approved referrals in the validation set. A correct prediction of whether or not a referral will be approved can be made in three out of four cases.

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Communication between primary care physicians and consultants

Cited by 124 publications

References 0 publications

Challenges in Referral Communication Between VHA Primary Care and Specialty Care

Challenges in Referral Communication Between VHA Primary Care and Specialty Care

Implementation Science Workshop: Implementation of an Electronic Referral System in a Large Academic Medical Center

When your words count: a discriminative model to predict approval of referrals

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