Topic
Referral
About: Referral is a research topic. Over the lifetime, 27614 publications have been published within this topic receiving 479918 citations.
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TL;DR: Nutritional assessment and intervention were not sufficiently applied by any professional at any stage of the pre-, actual and post-hospitalisation period.
115 citations
Journal Article•
TL;DR: Many of the patients with cancer seen by surgeons affiliated with regional cancer centres in Ontario may be experiencing significant delays in the assessment and treatment of their cancer.
Abstract: Background: There is evidence that delays in treatment result in increased psychosocial morbidity for patients diagnosed with cancer. We evaluated waiting times for care among cancer patients treated by surgeons affiliated with regional cancer centres in Ontario. Methods: Dates for 5 key events related to the surgical management of a patient with cancer were collected by a convenience sample of surgeons who treat breast, gynecologic, colorectal, head and neck, thoracic and urologic cancers. The key events were initial referral, first surgical visit, main treatment decision, major surgery and receipt of postoperative pathology report. The surgeons were also asked to judge the appropriateness of the waiting times for the intervals studied and to identify factors associated with inappropriate delays. Results: A total of 62 surgeons affiliated with 8 regional cancer centres participated; data were collected for 1456 patients who underwent assessment and whose surgical visit occurred between Jan. 31 and May 31, 2000. The median waiting time from referral to first visit was 11.0 days, from first visit to treatment decision 0.0 days, from treatment decision to surgery 20.0 days and from surgery to receipt of the pathology report 8.0 days. The median waiting times for the 2 summary intervals (referral to surgery and referral to receipt of the pathology report) were 37.0 and 48.0 days respectively. The waiting times varied by cancer type; for example, the median time from referral to surgery varied from 29.0 days for colorectal cancers to 64.0 days for urologic cancers. The same interval varied from 19.0 to 43.0 days by treatment centre. The waiting times did not vary substantially by patient age. The surgeons judged that 344 (37.2%) of the 925 patients with dates for the referral-to-surgery interval had inappropriately long waiting times. They indicated that contributing factors to these inappropriate waits were shortage of operating room time (in 181 cases), lack of other resources such as diagnostic tests or allied health personnel (in 156) and patient preference or circumstance (in 28) (factors were not mutually exclusive). Interpretation: Many of the patients with cancer seen by surgeons affiliated with regional cancer centres in Ontario may be experiencing significant delays in the assessment and treatment of their cancer.
115 citations
TL;DR: It is suggested that African-American adolescents' overrepresentation in community mental health clinics may in part be due to their disproportionate contact with social and legal agencies and the propensity of these agencies to rely more often on the mental health system than on families or schools.
Abstract: Few investigations have examined the referral of minority adolescents to community mental health clinics. This issue is especially critical in light of the increased attention given to mental health services for children and adolescents in recent years. The present study uses mental health clinic data from a large metropolitan area to explore whether African Americans and Mexican Americans entering mental health care do so through referrals that are more coercive than those made for Whites. The total sample consists of 2,460 adolescents aged 13-17; the results indicate that African-American adolescents are more likely than Whites to be referred by an external agency. When types of external agencies are considered, African Americans enter community mental health care more often than Whites through referrals from social agencies; Mexican Americans enter more often than Whites through school referrals. This paper suggests that African-American adolescents' overrepresentation in community mental health clinics may in part be due to their disproportionate contact with social and legal agencies and the propensity of these agencies to rely more often on the mental health system than on families or schools. Among all variables considered in the analyses for this paper, poverty status demonstrated the most consistent and powerful association with coercive referrals.
115 citations
TL;DR: Gatekeeping systems appear to be better able to contain ambulatory care expenditure, and relationships that exist at a micro level (such as lower costs with a gatekeeping primary care doctor) did not show up in aggregate data at a macro level.
Abstract: Objectives:It is generally assumed that health care systems in which specialist and hospital care is only accessible after referral by a general practitioner (GP) have lower total health care costs. In this study, the following questions were addressed: do health care systems with GPs acting as gatekeepers to specialized care have lower health care expenditure than those with directly accessible specialist care? Does health care expenditure increase more rapidly in countries without a referral system than in those with the GP acting as a gatekeeper?Methods:Multiple regression analyses on total and ambulatory health care expenditure in 18 OECD countries.Results:Analyses showed only one statistically significant effect (P< 0.05) in countries with gatekeeping GPs: ambulatory care expenditure has increased more slowly than in non-gatekeeping systems. No significant effects of gatekeeping were found on the level of ambulatory care costs, or on the level or growth of total health care expenditure. As in earlier...
115 citations
TL;DR: Routine referral of patients with metastatic cancer for psychosocial oncology care was predicted by presence of more severe depressive symptoms, younger age, and unmarried status, consistent with some aspects of Andersen's model of health care utilization.
Abstract: Purpose This study examines the rate and prediction of referral for specialized psychosocial oncology care in 326 patients with metastatic GI or lung cancer. Patients and Methods Referral information was abstracted from medical records and hospital databases. Patients completed measures of psychosocial and physical distress and functioning. Results Routine referral occurred in 33% of patients, and in 42% and 44%, respectively, of those scoring high on measures of depression (Beck Depression Inventory [BDI]-II ≥ 15) and hopelessness (Beck Hopelessness Scale ≥ 8). Univariate analyses indicated that referral was associated with younger age, unmarried status, living alone, presence of more depressive symptoms, hopelessness, and attachment anxiety, and with less social support, self-esteem, and spiritual well-being (all P < .05). Among the significantly depressed (BDI-II ≥ 15), 100% of those less than 40 years of age, but only 22% of those age 70 years or older were referred. Multivariate analyses indicated th...
115 citations