Referral

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

Randomised controlled trial of effect of leaflets to empower patients in consultations in primary care.

Abstract: Objective To assess the impact of leaflets encouraging patients to raise concerns and to discuss symptoms or other health related issues in the consultation. Design Randomised controlled trial. Setting Five general practices in three settings in the United Kingdom. Participants 636 consecutive patients, aged 16-80 years, randomised to receive a general leaflet, a depression leaflet, both, or neither. Main outcomes Mean item score on the medical interview satisfaction scale, consultation time, prescribing, referral, and investigation. Results The general leaflet increased patient satisfaction and was more effective with shorter consultations (leaflet 0.64, 95% confidence interval 0.19 to 1.08; time 0.31, 0.0 to 0.06; interaction between both -0.045, -0.08 to—0.009), with similar results for subscales related to the different aspects of communication. Thus for a 10 minute consultation the leaflet increased satisfaction by 7% (seven centile points) and for a five minute consultation by 14%. The leaflet overall caused a small non-significant increase in consultation time (0.36 minutes, -0.54 to 1.26). Although there was no change in prescribing or referral, a general leaflet increased the numbers of investigations (odds ratio 1.43, 1.00 to 2.05), which persisted when controlling for the major potential confounders of perceived medical need and patient preference (1.87, 1.10 to 3.19). Most of excess investigations were not thought strongly needed by the doctor or the patient. The depression leaflet had no significant effect on any outcome. Conclusions Encouraging patients to raise issues and to discuss symptoms and other health related issues in the consultation improves their satisfaction and perceptions of communication, particularly in short consultations. Doctors do, however, need to elicit expectations to prevent needless investigations.

Influence of gender, race, and education on patient preferences and receipt of cardiac catheterizations among coronary care unit patients

Abstract: The extent to which a preference for less aggressive care explains the lower rate of invasive cardiac services for women and African-Americans is unknown. A prospective observational study of 272 patients admitted to the coronary care unit was conducted at a tertiary referral teaching hospital and a community teaching hospital. In stepwise multivariate analysis, having less than a college education, poor cardiac function, not having undergone a previous cardiac catheterization, being a patient in a nonreferral community hospital, and current smoking were positively associated with a patient's stating that he or she would disagree with a physician's recommendation for a cardiac catheterization. The stepwise multivariate model with cardiac catheterization as the dependent variable indicated that being a patient in a referral medical center, patient willingness to accept a physician's recommendation for a cardiac catheterization, severe heart disease, and having attended high school were predictive. Women did not differ from men in their preference for or receipt of cardiac catheterization. Patients in the coronary care unit with lower levels of education were less likely to undergo cardiac catheterization. This association was only partly explained by less educated patients' being less willing to accept a physician's recommendation to undergo cardiac catheterization.

Developmental surveillance of infants and young children in pediatric primary care.

Abstract: Purpose of review This article reviews the importance of appropriate developmental surveillance in early childhood, what is known about its effectiveness in current pediatric practice, and ways in which its delivery can be improved to optimize child outcomes. Recent findings Many infants and young children with developmental delays or risk factors for poor developmental outcomes are not identified by pediatric practitioners in a timely manner. When they are identified, they are often not referred to appropriate early intervention services or early childhood development programs. They are therefore denied the opportunity to benefit from programs documented to have long-lasting benefits for children. Structuring developmental screening around the use of validated parent questionnaires improves the rates at which children with developmental needs are appropriately identified. At the same time, lowering thresholds for referral improves the rates at which children with identified needs receive appropriate services. Summary Pediatric practitioners are uniquely positioned to improve children's developmental outcomes through early identification and referral of children with developmental delays or risk factors for poor developmental outcomes. Unfortunately, inappropriate screening practices, high thresholds for referral, misplaced concerns about causing parental anxiety, and unfamiliarity with local resources all diminish the effectiveness with which many practitioners conduct developmental surveillance. Recent studies show that small changes in screening and referral practices have the potential to greatly improve the effectiveness of developmental surveillance. This, in turn, has the potential to improve lifelong outcomes for children.

Environmental Medicine: Integrating a Missing Element into Medical Education

Abstract: People are increasingly concerned about potential environmental health hazards and often ask their physicians questions such as: "Is the tap water safe to drink?" "Is it safe to live near power lines?" Unfortunately, physicians often lack the information and training related to environmental health risks needed to answer such questions. This book discusses six competency based learning objectives for all medical school students, discusses the relevance of environmental health to specific courses and clerkships, and demonstrates how to integrate environmental health into the curriculum through published case studies, some of which are included in one of the book's three appendices. Also included is a guide on where to obtain additional information for treatment, referral, and follow-up for diseases with possible environmental and/or occupational origins.