Referral

About: Referral is a research topic. Over the lifetime, 27614 publications have been published within this topic receiving 479918 citations.

The effect of age on referral to and use of specialist palliative care services in adult cancer patients: a systematic review

Abstract: Objective: to investigate variations in the use of specialist palliative care (SPC) services for adult cancer patients, in relation to age. Design: systematic review of studies examining use of or referral to SPC services in adult cancer patients. Search strategy and selection criteria: six electronic databases (Medline, Embase, Web of Science, HMIC, SIGLE and AgeInfo) were searched for studies published between 1966 and March 2005, and references in the articles identified were also examined. Inclusion criteria were all studies which provided data on age in relation to use of or referral to SPC. Two reviewers independently selected studies, extracted data and assessed methodological quality according to defined criteria. Main outcome measures: use of or referral to SPC services, determined from all sources of report (patient, informal carer, health care professional, health care records). Results: 14 studies were identified. All reported a statistically significant lower use of SPC among older cancer patients (65 and above or older) at a univariate level [crude odds ratios ranged from 0.33 (0.15–0.72) to 0.82 (0.80–0.82)]. However, there were important methodological weaknesses in all of the studies identified; most crucially, studies failed to consider variations in use in relation to need for SPC. Conclusions: there is some evidence that older people are less likely to be referred to, or to use, SPC. These findings require confirmation in studies using prospectively collected data which control for patient’s need for SPC.

Patient, physician, and community factors affecting referrals to specialists in Ontario, Canada: a population-based, multi-level modelling approach.

Abstract: QUESTION ADDRESSED. This population-based study examines the factors affecting referrals by primary care physicians (PCPs) to specialists. MATERIALS AND METHODS. Multilevel Poisson models were used to test the impact of patient, physician and community-level variables on the referral rate (the number of office-based specialist referrals per patient by the patient's customary PCP in fiscal year 1997/98). Patients from each of 6972 PCPs with sufficient data in Ontario were examined. RESULTS. The average patient had 0.56 referrals per year (range 0-61). Referrals were higher at ages 1 and 77 to 78, and among women of childbearing age. Chronic disease variables were strongly correlated with referral rates. Patients in poor neighborhoods had more referrals, because they had more chronic diseases. After controlling for disease, individuals in the top 9% wealthiest neighborhoods had 4% more referrals. Female physicians made 8% more referrals than men. Older physicians referred more because they saw older patients; after controlling for patient age, physician age had no effect. Referrals were 14% higher in cities with medical schools compared with other cities and 12% lower in small towns. However, local specialist supply was unrelated to referral rates. CONCLUSION. This study improves our understanding of the impact of physician gender and age on referrals. It suggests that community type, not specialist supply, predicts variations in referrals. Lastly, it identifies preferential access to specialists among high-income earners, even within Canada's universal health insurance system. However, this effect is modest, suggesting that the system does provide reasonably equitable access to referrals.

A systematic review of strategies for partner notification for sexually transmitted diseases, including HIV/AIDS:

Abstract: This review compares the effects of various sexually transmitted disease (STD) partner-notification strategies. Using review methods endorsed by the Cochrane Collaboration, it updates previous reviews, and addresses some of their methodological limitations. It includes 11 randomized controlled trials (RCTs) comparing two or more strategies, including 8014 participants. Only two trials were conducted in developing countries, and only two trials were conducted among HIV-positive patients. The review found moderately strong evidence that: (1) provider referral alone, or the choice between patient and provider referral, when compared with patient referral among patients with HIV or any STD, increases the rate of partners presenting for medical evaluation; (2) contract referral, when compared with patient referral among patients with gonorrhoea, results in more partners presenting for medical evaluation; (3) verbal, nurse-given health education together with patient-centred counselling by lay workers, when compared with standard care among patients with any STD, results in small increases in the rate of partners treated. The review concludes that there is a need for evaluations of interventions combining provider training and patient education, for evaluations conducted in developing countries, and for the measurement of potential harmful effects.

Evaluation of 2 Screening Strategies for Early Identification of Patients with Axial Spondyloarthritis in Primary Care

Abstract: Objective. To evaluate 2 referral strategies for axial spondyloarthritis (SpA) in patients with chronic low back pain at the primary care level. Methods. Referral physicians (n = 259) were randomly assigned to either Strategy 1 or Strategy 2 in order to refer patients with chronic back pain (duration > 3 months), age at onset of back pain Results. In total, 560 consecutively referred patients were included in the analysis. Among 318 patients referred by Strategy 1, 41.8% (95% CI 36.5%–47.3%) were diagnosed with definite axial SpA. Among 242 patients referred by the second strategy, definite axial SpA was diagnosed in 36.8% (95% CI 31.0%–43.0%) of the cases. Conclusion. Both referral strategies demonstrated comparable performance in identification of patients with axial SpA. Strategy 1 might be preferred as an easy and reliable screening method for axial SpA at the primary care level.