Self‐referral to specialists – a dodgy proposition

Makkar, Ravinder P S; Monga, Amitabh; Arora, Anju; Mukhopadhyay, Surabhi; Gupta, Ajay

doi:10.1108/09526860310465591

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…Finally, in concert with market-driven changes in health care, this analysis does not include patients seeking specialists without a referral, as in many managed care systems, PCPs act as a gatekeeper responsible for authorizing access to specialty care (Franks et al , 1992). Self-referrals by patients are often misdirected and not recommended (Makkar et al , 2003), thereby increasing the practical implications of this research.…”

Section: Methodsmentioning

confidence: 99%

Reducing referral leakage: an analysis of health-care referrals in a service ecosystem

O’Connor

Cook

2020

JSM

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Purpose The purpose of this paper is to address a critical problem for health-care organizations: patient referral leakage. This paper explores the nature of patient referrals by examining how health-care providers’ breadth and depth of connectivity within a hospital network and identification with each other influence the likelihood of future patient referrals. Design/methodology/approach The data was collected by using a multi-sourced data set from the health-care industry. The proposed model was tested by using logistic regression to determine the likelihood of a primary care physician’s (PCP) referral to a specialist within a hospital network. Findings A model linking provider connectivity to examine co-creation practices in the form of patient referrals is tested. Results indicate that patient referrals are multidimensional. A PCP’s likelihood to refer to a specialist within the hospital network is influenced by the breadth and depth of connectivity of each provider. Research limitations/implications This investigation extends service ecosystems to patients, health-care providers and hospital organizations, making it the first to explore how different degrees of connectivity (breadth of referral partners and depth of exchange) between and among health-care providers influence the likelihood of future patient referrals. Findings complement extant literature on service ecosystems by empirically showing that provider relationships are interdependent and rely on the mutual coordination of benefits within the entire health-care organization and network. Practical implications Managers and health-care professionals can use the framework to build and strengthen relational ties/alliances within a service organization. An ecosystems perspective reduces patient referral leakage through enhanced organizational performance, competitive advantage and continuity of care. Originality/value The authors offer a novel view of referral relationships using hard-to-access proprietary data. Moreover, this study responds to the need for transformative service research by offering service researchers and policymakers a means to enhance consumer well-being. The main contribution of this study is a framework to gain a better understanding of patient referral relationships between employees (i.e., health-care providers) in an organization, thereby affording an opportunity to bolster operational efficiencies, improve clinical outcomes and strengthen referral pathways. By viewing health-care networks through a service ecosystems perspective, contextual boundaries and the relative power of relationships are also identified. The novel use of rarely available hospital data in this setting helps explain how patient leakage compromises the health of the ecosystem and its members.

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Section: Methodsmentioning

confidence: 99%

Reducing referral leakage: an analysis of health-care referrals in a service ecosystem

O’Connor

Cook

2020

JSM

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“…The patient would then need to find the right specialist -a challenge in itself. 4 This is without taking into account that 15-39% of GP consultations are for symptoms that are medically unexplained. 5 It takes a skilled GP to contain and manage medically unexplained symptoms in primary care: by processing the biological, psychological, and social aspects of the presentation, often over time.…”

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confidence: 99%

In this uncertain world, patient-centred care must not mean patient-led care

Miller

Fritz

2019

Br J Gen Pract

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NAVIGATING THE DIAGNOSIS Picture the scene: you are climbing down a mountain and the fog descends. You can no longer see further than 5 metres. The two-dimensional map you are following does not capture the three-dimensional landscape you are navigating; you cannot get your bearings, and you do not know what is coming. Now imagine that you are with a guide who has walked the path you are on thousands of times before. What would you want them to do? The similarities between helping an individual to navigate a treacherous mountain and the process of making a diagnosis and treatment plan in primary care make this a pertinent analogy. The primary care physician navigates undifferentiated diagnostic situations, simultaneously processing the biological, psychological, and social aspects of the presentation. 1 This process of decision making in the face of uncertainty requires learnt intuition: utilising the technical, personal, and conceptual skills of the GP. These skills arise from prolonged practice, exposure, and feedback. 2 Just as the mountain guide draws on their honed intuition to provide a path to safety, so too does the GP. However, this professional intuition is under attack. An article in the Telegraph proposed that we should do away with GPs and that the public should provide their own primary care with 'apps, robots, online self-diagnosis and over-the-counter medicines'. 3 A popular view is that this is the natural extension of patient-centred care, facilitating patients to make informed, autonomous decisions. But if patients are being asked to sort and prioritise their own symptoms, and analyse and choose options available to them, this is not so much patient-centred as patient-led care. ADVERSE CONSEQUENCES OF PATIENT-LED CARE Although there are some conditions and minor illnesses for which this patient-led approach will be effective, unfortunately there are also many situations where this approach may be ineffective and/or dangerous. The clinical process is shrouded in uncertainty. GPs apply their skill and experience to rule out or investigate the worrying and sinister causes, and frequently utilise watchful waiting and bestfit treatments as diagnostic tools. They

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Utilization Of The Health Care Delivery System In A District Of North India

Bhola¹,

Kumari²,

Nidha³

2009

East Afr. J. Pub. Health

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Background: India has one of the most extensive health infrastructures-a three-tier hierarchical referral system-for the provision of effective and efficient health services to the majority of its population. In this study we have tried to evaluate the utilization of such a wide health infrastructure and the various factors affecting it. We have also tried to find the factors that motivated the patients to visit the present health facility and the key persons who motivated them to do so. Methods: Time bound cross-sectional study. Setting: Three types of referral health facilities in Lucknow District Participants: A total of 1265 patients were interviewed during the four months of the period of survey from these three types of referral health facilities. Results: The present study revealed that majority of the patients coming to all the three referral centres were the new patients (89%), about two-thirds of whom had come there directly. Overall, only one tenth of the patients attending the secondary and tertiary level public health facilities were referred by someone. Most of the indirect patients had self referred themselves. About eight and nine percent of the indirect and referred patients could reach the present site of treatment only after more than two years of rummaging and about 13% and 11% had spent more than ten thousand rupees respectively, which in some cases even amounted to lakh rupees. Conclusions: The utilization of the referral system of the health care delivery in India needs to be augmented. Before planning future reforms such as decentralization, incorporation of the Indian system of Medicine, and other steps we need to develop mechanisms to see that the plans are materialized.

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Self‐referral to specialists – a dodgy proposition

Cited by 3 publications

References 5 publications

Reducing referral leakage: an analysis of health-care referrals in a service ecosystem

Reducing referral leakage: an analysis of health-care referrals in a service ecosystem

In this uncertain world, patient-centred care must not mean patient-led care

Utilization Of The Health Care Delivery System In A District Of North India

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