Referral interventions from primary to specialist care: a systematic review of international evidence

Abstract

BackgroundDemand management defines any method used to monitor, direct, or regulate patient referrals. Strategies have been developed to manage the referral of patients to secondary care, with interventions that target primary care, specialist services, or infrastructure. AimTo review the international evidence on interventions to manage referral from primary to specialist care. Design and settingSystematic review. MethodIterative, systematic searches of published and unpublished sources public health, health management, management, and grey literature databases from health care and other industries were undertaken to identify recent, relevant studies. A narrative synthesis of the data was completed to structure the evidence into groups of similar interventions. ResultsThe searches generated 8327 unique results, of which 140 studies were included. Interventions were grouped into four intervention categories: GP education (n = 50); process change (n = 49); system change (n = 38); and patient-focused (n = 3). It is clear that there is no 'magic bullet' to managing demand for secondary care services: although some groups of interventions may have greater potential for development, given the existing evidence that they can be effective in specific contexts.

Integrating primary and secondary care for children and young people: sharing practice

“…Parab et al conducted a systematic review (2013) of specialist home-based nursing services for children evaluating a hospital at home alternative to admissions for acutely ill children 12–16. Blank and colleagues published a systematic review of ‘gatekeeping services’ for referral from primary to planned secondary care, relevant to the advice and guidance service in Taunton 17. Ke and colleagues conducted a systematic review on the cost-effectiveness of teleconferencing for MDTs in adult secondary care 18…”

“…Generally, the evidence included in the reviews is weak, with a high likelihood of bias even for the handful of randomised controlled trials evaluating hospital at home and gatekeeping services into secondary care 17 18. Most relevant evidence comes from before and after studies, not always with a control group 10 11 17 19…”

“…Most relevant evidence comes from before and after studies, not always with a control group 10 11 17 19…”

Exploring the factors that influence the public health impact of changes to the traditional housing officer’s role: insights from a logic modelling approach

“…Our approach of building a logic model systematically from primary and secondary evidence is a novel methodology that contrasts with the approach traditionally adopted, whereby logic models are built by discussion and consensus at meetings of stakeholders or expert groups (Baxter 2010). The processes we adopted here build on our previous work of developing logic models as part of a systematic review process (Blank et al 2014(Blank et al , 2016Baxter et al 2010), as we also incorporated primary data collection and analysis into the process. Development of this logic model was, therefore, supported by a range of data generation methods, including a scoping review of the literature, telephone survey with housing tenants, in-depth interviews with tenants and housing staff, and workshops with key stakeholders to help to develop and then validate the model.…”

“…In this study, we extended our previous approach of using systematic review methodologies to develop logic models (Blank et al 2014(Blank et al , 2016Baxter et al 2010) by incorporating extracted secondary data from published studies, along with primary data from interviews and a telephone survey, which were combined and treated as textual (qualitative) data. A process of charting and categorising the various data sources leads to a thematic synthesis (18) of the extracted quantitative and qualitative data, which, in turn, leads to developing individual elements of the model.…”