Interventions to improve outpatient referrals from primary care to secondary care

Akbari, Ayub; Mayhew, Alain; Al-Alawi, MA; Grimshaw, J; Winkens, RAG; Glidewell, E; Pritchard, Chanie; Thomas, Ruth; Fraser, Cynthia

doi:10.1002/14651858.cd005471

Cited by 159 publications

(250 citation statements)

References 25 publications

(15 reference statements)

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“…As part of the systematic approach, evidence supports using visits to GP surgeries by 'link-workers' (mental health practitioners) -recently launched by the Newry and Mourne PMHC -to promote further collaboration between GPs and PMHC. Involvement of consultants in local educational activities in addition to link-worker (mental health practitioner) visits to local surgeries would be desirable as these have been shown to be effective in improving the appropriateness of outpatient referral (Akbari et al 2008). This provides the opportunity for the psychiatrist to play a key role in developing the interface with primary care (Gask & Khanna, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…General practitioners (GPs) refer patients that need specialized care, but inappropriate or inadequate referral can delay the assessment of patients, leading to discontent amongst clinicians and tensions across the primary-secondary care interface (Chew-Graham et al 2008). In effect, the quality of referrals to PMHC has implications for patients, the health care system and health care costs (Akbari et al 2008).…”

Section: Introductionmentioning

confidence: 99%

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Improving general practitioners’ referral details of antidepressant use for patients referred for depression to primary mental health care: re-audit

Towobola¹,

Cunningham²,

Cotter³

2015

Ir. j. psychol. Med.

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Background. This audit cycle looked at details of antidepressants given in general practitioners' (GPs) referral letters to Primary Mental Health Care (PMHC). With adequate information when patients are referred, time spent in clarifying details could be put into better use by clinicians and prompt effective treatment would help to reduce the direct and indirect costs of depression.Objective. To evaluate how effective our intervention was 7 months after a previous audit and identify areas that need improvement.Method. Audit of 33 referral letters of patients referred for depression from GPs to a PMHC service in Northern Ireland, followed by the intervention (feedback and pro forma) and re-audit after 7 months.Results. The April audit showed 100% documentation of current antidepressant treatment and dose, but showed poor documentation of previous antidepressant use (33%), dose or duration (15%) and the reason for stopping the treatment (3%). Following intervention, the re-audit showed 25% and 24% rise in documenting previous antidepressant used and maximum dose reached, respectively, and 20% rise in documenting the reason for stopping.Conclusions. Our interventions made modest improvement in providing relevant data in referral letters. This study adds to the existing evidence that relying mainly on feedback as a method of implementing change is ineffective. Lack of enthusiasm for using the newly introduced pro forma suggests that mental health services should obtain more effective ways of engaging GPs in service development. Using a systematic approach, which includes identifying local barriers to change and providing a supportive environment are important before the next re-audit.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving general practitioners’ referral details of antidepressant use for patients referred for depression to primary mental health care: re-audit

Towobola¹,

Cunningham²,

Cotter³

2015

Ir. j. psychol. Med.

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“…This strategy could be effectively applied to subspecialty inpatient orthopaedic consultations by utilising a structured referral proforma [8], providing a list of referral guidelines and standardised investigations (recommended X-ray projections, blood tests), each dependent on the differential diagnosis, to be completed as a pre-requisite to referral. Such a system could be incorporated into the hospital information communication technology (ICT) system and would likely reduce the need for second visits and consequent delay in final opinion.…”

Section: Discussionmentioning

confidence: 99%

Inpatient consultations to an orthopaedic service: the hidden workload

et al. 2011

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“…The system of medical referral for subspecialty care, varies across regions and providers. Issues related to under-referral of patients who would benefit from earlier subspecialty care and over-referral increasing the costs of medical care could potentially be improved with structured referral information provided to secondary care providers and secondary care acknowledgement of appropriate use of guidelines in primary care (Akbari et al 2011). The perception of coordinated care with subspecialists is improved when the primary care provider initiates and communicates with the subspecialty referral source (OMalley and Cunningham 2009).…”

Section: Clinician Satisfaction and The Medical Home For Asdmentioning

confidence: 99%

Autism and Pediatric Practice: Toward a Medical Home

Hyman

Johnson

2012

J Autism Dev Disord

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The pediatrician sees a child for 11 well child visits by their third birthday. The provision of continuous primary care supports development of trust with parents, provides opportunity for screening and surveillance of autism spectrum disorders (ASD), allows monitoring the progress of children requiring therapy, and a framework to support and educate families. Families of children with ASD are less likely to report that they receive care in a Medical Home, a practice providing coordinated, accessible, continuous, culturally competent care. They report less access to specialty and family focused care compared to other children with special health care needs. It is a major challenge to identify and effect the solutions necessary to bring Medical Home care to all children with ASD.

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Interventions to improve outpatient referrals from primary care to secondary care

Cited by 159 publications

References 25 publications

Improving general practitioners’ referral details of antidepressant use for patients referred for depression to primary mental health care: re-audit

Improving general practitioners’ referral details of antidepressant use for patients referred for depression to primary mental health care: re-audit

Inpatient consultations to an orthopaedic service: the hidden workload

Autism and Pediatric Practice: Toward a Medical Home

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