Referral

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

A systematic review of the effect of primary care-based service innovations on quality and patterns of referral to specialist secondary care.

Abstract: BACKGROUND: Innovations are proliferating at the primary-secondary care interface, affecting referral to secondary care and resource use. Evidence about the range of effects and implications for the healthcare system of different types of innovation have not previously been summarised. AIM: To review the available evidence on initiatives affecting primary care referral to specialist secondary care. SETTING: Studies of primary-secondary care interface. METHOD: Systematic review of trials, using adapted Cochrane Collaboration (effective practice and organisation of care) criteria. Studies from 1980 to 2001 were identified from a wide range of sources. Strict inclusion criteria were applied, and relevant clinical, service and cost data extracted using an agreed protocol. The main outcome measures were referral rates to specialist secondary care. RESULTS: Of the 139 studies initially identified. 34 met the review criteria. An updated search added a further 10 studies. Two studies provided economic analysis only. Referral was not the primary outcome of interest in the majority of included studies. Professional interventions generally had an impact on referral rates consistent with the intended change in clinician behaviour. Similarly, specialist 'outreach' or other primary care-based specialist provider schemes had at least a small effect upon referral rates to secondary care with the direction of effect being that intended or rational from a clinical and sociological perspective. Of the financial interventions, one was aimed primarily at changing the numbers or proportion of referrals from primary to specialist secondary care, and the direction of change was as expected in all cases. The quality of the reporting of the economic components of the 14 studies giving economic data was poor in many cases. When grouped by intervention type, no overall pattern of change in referral costs or total costs emerged. CONCLUSION: The studies identified were extremely diverse in methodology, clinical subject, organisational form, and quality of evidence. The number of good quality evaluations of innovative schemes to enhance the existing capacity of primary care was small, but increasing. Well-evaluated service initiatives in this area should be supported. Organisational innovations in the structure of service provision need not increase total costs to the National Health Service (NHS), even though costs associated with referral may increase. This review provides limited, partial, and conditional support for current primary care-oriented NHS policy developments in the United Kingdom.

A randomised controlled trial of the Home Independence Program, an Australian restorative home-care programme for older adults

Abstract: A randomised controlled trial was conducted to test the effectiveness of the Home Independence Program (HIP), a restorative home-care programme for older adults, in reducing the need for ongoing services. Between June 2005 and August 2007, 750 older adults referred to a home-care service for assistance with their personal care participated in the study and received HIP or 'usual' home-care services. Service outcomes were compared at 3 and 12 months. Subgroups of 150 from each group were also compared on functional and quality of life measures. Data were analysed by 'intention-to-treat' and 'as-treated'. The intention-to-treat analysis showed at 3 and 12 months that the HIP group was significantly less likely to need ongoing personal care [Odds ratio (OR) = 0.18, 95% CI = 0.13-0.26, P < 0.001; OR = 0.22, 95% CI = 0.15-0.32, P < 0.001]. Both subgroups showed improvements on the individual outcome measures over time with the only significant differences being found at 12 months for Instrumental Activities of Daily Living (IADL) in the as-treated analysis. Contamination of the control group by an increased emphasis on independence across the home-care agency involved, together with other methodological problems encountered, is thought to account for the few differences between groups in individual outcomes. Despite no difference between the groups over time in their overall ADL scores, a significantly smaller proportion of the HIP group required assistance with bathing/showering, the most common reason for referral, at 3 and 12 months. The results support earlier findings that participating in a short-term restorative programme appears to reduce the need for ongoing home care. The implementation of such programmes more broadly throughout Australia could substantially offset the projected increase in demand for home care associated with the five-fold projected increase in numbers of the oldest old expected over the next 40 years.

Offending by adults with learning disabilities and the attitudes of staff to offending behaviour: implications for service development.

Abstract: The aims of this study were: (I) to identify all adults with learning disabilities living in residential homes or attending day services in the Cambridge Health District in contact with the criminal justice system during 1992; (2) to evaluate the responses of services involved; and (3) to investigate the attitudes of staff and the policies of the services to 'offending behaviour'. Details of offences committed and the response of the police, health and social services, and other agencies were obtained by direct interview with the senior staff and through examination of case records. The attitudes of staff to offending behaviour was investigated by the use of a semi-structured questionnaire. Seven (2%) out of 358 adults with learning disabilities were reported to have had contact with the police during 1992. The eight offences allegedly committed by the seven people were two acquisitive offences, two sexual offences, one assault, one wasting of police time, one offence against the Public Order Act and one traffic offence. One offender was cautioned after the Crown Prosecution Service discontinued the case because of lack of evidence, while the other alleged offenders received informal warnings. None of the seven alleged offenders were prosecuted. Three alleged offenders lived in hostel accommodation, yet hostel accommodation only accounts for 7.8% of adults with learning disabilities living in the Cambridge Health District. Because of a lack of operational policies on offending behaviour, there were no existing referral structures for people who might need specialist health service support. Referrals tended to be inconsistent, with a considerable time-lag between offence and referral. Tolerance levels towards offending behaviour were extremely high in the two hostels, 20 group homes and day centres which were included in this study. Theft and criminal damage was hardly ever reported. Thirty establishments were visited during the course of this study. Of these establishments, staff in 12 said they would always report a major assault. In only three would a sexual assault or indecent exposure always be reported if it was to occur. Staff at one residential establishment said they would hesitate to report rape and the staff in another two would consider the circumstances before reporting it to the police.