Referral

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

Comparison of two referral strategies for diagnosis of axial spondyloarthritis: the Recognising and Diagnosing Ankylosing Spondylitis Reliably (RADAR) study

Abstract: Objective To determine which of two referral strategies, when used by referring physicians for patients with chronic back pain (CBP), is superior for diagnosing axial spondyloarthritis (SpA) by rheumatologists across several countries. Methods Primary care referral sites in 16 countries were randomised (1 : 1) to refer patients with CBP lasting >3 months and onset before age 45 years to a rheumatologist using either strategy 1 (any of inflammatory back pain (IBP), HLA-B27 or sacroiliitis on imaging) or strategy 2 (two of the following: IBP, HLA-B27, sacroiliitis, family history of axial SpA, good response to non-steroidal anti-inflammatory drugs, extra-articular manifestations). The rheumatologist established the diagnosis. The primary analysis compared the proportion of patients diagnosed with definite axial SpA by referral strategy. Results Patients (N=1072) were referred by 278 sites to 64 rheumatologists: 504 patients by strategy 1 and 568 patients by strategy 2. Axial SpA was diagnosed in 35.6% and 39.8% of patients referred by these respective strategies (between-group difference 4.40%; 95% CI −7.09% to 15.89%; p=0.447). IBP was the most frequently used referral criterion (94.7% of cases), showing high concordance (85.4%) with rheumatologists9 assessments, and having sensitivity and a negative predictive value of >85% but a positive predictive value and specificity of Conclusions A referral strategy based on three criteria leads to a diagnosis of axial SpA in approximately 35% of patients with CBP and is applicable across countries and geographical locales with presumably different levels of expertise in axial SpA.

Access to weight reduction interventions for overweight and obese patients in UK primary care: population-based cohort study

Abstract: Objectives To investigate access to weight management interventions for overweight and obese patients in primary care. Setting UK primary care electronic health records. Participants A cohort of 91 413 overweight and obese patients aged 30–100 years was sampled from the Clinical Practice Research Datalink (CPRD). Patients with body mass index (BMI) values ≥25 kg/m 2 recorded between 2005 and 2012 were included. BMI values were categorised using WHO criteria. Interventions Interventions for body weight management, including advice, referrals and prescription of antiobesity drugs, were evaluated. Primary and secondary outcome measures The rate of body weight management interventions and time to intervention were the main outcomes. Results Data were analysed for 91 413 patients, mean age 56 years, including 55 094 (60%) overweight and 36 319 (40%) obese, including 4099 (5%) with morbid obesity. During the study period, 90% of overweight patients had no weight management intervention recorded. Intervention was more frequent among obese patients, but 59% of patients with morbid obesity had no intervention recorded. Rates of intervention increased with BMI category. In morbid obesity, rates of intervention per 1000 patient years were: advice, 60.2 (95% CI 51.8 to 70.4); referral, 75.7 (95% CI 69.5 to 82.6) and antiobesity drugs 89.9 (95% CI 85.0 to 95.2). Weight management interventions were more often accessed by women, older patients, those with comorbidity and those in deprivation. Follow-up of body weight subsequent to interventions was infrequent. Conclusions Limited evidence of weight management interventions in primary care electronic health records may result from poor recording of advice given, but may indicate a lack of patient access to appropriate body weight management interventions in primary care.

General practitioner outpatient referrals: do good doctors refer more patients to hospital?

Abstract: OBJECTIVE--To investigate the relation between general practitioners' referral rates to individual specialties and the individual areas of expertise of the referring doctors. DESIGN--Data collected on referral patterns in one group practice over nine months. SETTING--General practice in suburban Birmingham consisting of five partners and a trainee. RESULTS--In 395 referrals there were large differences in referral patterns among partners for otorhinolaryngology, ophthalmology, general surgery, and dermatology. The doctors with particular expertise in otorhinolaryngology and ophthalmology had high referral rates to those specialties, and these differences persisted after allowing for case mix. CONCLUSION--A high referral rate does not necessarily imply a high level of inappropriate referral.

Assessment of an inner city visual screening programme for preschool children.

Abstract: AIMS--The efficiency of preschool visual screening programmes to detect amblyopia is questionable. In this study such a programme in an inner city was assessed to determine its effectiveness. METHODS--The results of screening and hospital treatment of 712 patients who were considered to require referral were entered into a database for analysis. Default rates were assessed and the efficacy of treatment determined. RESULTS--The only effective screening test for the detection of amblyopia was visual acuity. A large proportion of referred patients had refractive problems only. High default rates, particularly in geographical areas of lower socioeconomic grading, severely handicapped any attempt to reduce the incidence of amblyopia. CONCLUSION--A fresh approach to the detection and care of amblyopia in the inner city community is required, perhaps by performing screening of children in their first year of attendance at school to reduce default rates. Cycloplegic refraction of children who are found to have reduced visual acuity before their referral to hospital is also recommended.