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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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Journal ArticleDOI
TL;DR: Project Bridge has demonstrated that it is possible to maintain HIV-positive ex-offenders in medical care through the provision of ongoing case management services following prison release.
Abstract: Human immunodeficiency virus (HIV) infection is more prevalent among the incarcerated than the general population. For many offenders, incarceration is the only time that they may access primary care. Project Bridge is a federally funded demonstration project that provides intensive case management for HIV-positive exoffenders being released from the Rhode Island state prison to the community. The program is based on collaboration between colocated medical and social work staff. The primary goal of the program is to increase continuity of medical care through social stabilization; it follows a harm reduction philosophy in addressing substance use. Program participants are provided with assistance in accessing a variety of medical and social services. The treatment plan may include the following: mental illness triage and referral, substance abuse assessment and treatment, appointments for HIV and other medical conditions, and referral for assistance to community programs that address basic survival needs. In the first 3 years of this program, 97 offenders were enrolled. Injection drug use was reported by 80% of those enrolled. There were 90% followed for 18 months, 7% moved out of state or died, and 3% were lost to follow-up. Reincarceration happened to 48% at least once. Of those expressing a need, 75% were linked with specialty medical care in the community, and 100% received HIV-related medical services. Of those expressing a need for substance abuse treatment, 67% were successful in keeping appointments for substance abuse treatment within the community. Project Bridge has demonstrated that it is possible to maintain HIV-positive ex-offenders in medical care through the provision of ongoing case management services following prison release. Ex-offenders will access HIV-related health care after release when given adequate support.

200 citations

Journal ArticleDOI
TL;DR: This paper examined the stigma associated with psychological problems among service members returning from the United States peacekeeping mission to Bosnia and found that admitting a psychological problem in the military is perceived as muchmore stigmatizing than admitting a medical problem.
Abstract: The present research examined the stigma associated with psychological problems among service members returning from the United States peacekeeping mission to Bosnia. The results show that admitting a psychological problem in the military is perceived as muchmore stigmatizing than admitting a medical problem. Service members had more concerns about stigmatization and felt more uncomfortable discussing psychological problems than medical problems, and these feelings were magnified when service members were being screened with their units rather than alone. Service members also reported a lesser likelihood of following through with a psychological referral than with a medical referral. However, participants who discussed psychological issues with a therapist felt the screening was more beneficial than those who did not discuss their responses. The results address the neglected topic of the stigma associated with psychological problems in the workplace.

200 citations

Journal ArticleDOI
TL;DR: Language barriers may decrease the likelihood that a patient is given a follow-up appointment after an emergency department visit, however, patients who experienced language barriers were equally likely to comply with follow- up appointments.
Abstract: Research has shown that Latinos average fewer physician visits per year than other ethnic groups.1,2 Many factors may contribute to Latinos' lower use of physician services, including lower rates of health insurance coverage,3 lower levels of income and education,3,4 and limited English proficiency.5–7 One study found that Latinos with limited English proficiency reported fewer visits than native English-speaking patients,8 while an analysis of the 1987 National Medical Expenditure Survey found that insurance was the predominant determinant of the number of physician visits and inability to speak English was not a significant predictor of physician visits.9 Patients with limited English proficiency may also utilize health care less because of dissatisfaction with the health care they have received in the past. Baker et al. found that Latino patients who communicated through an interpreter or who did not have an interpreter when they thought one was necessary were less satisfied with the patient-provider relationship.10 Similarly, Carrasquillo et al. reported that emergency department patients who said that English was not their first language were less satisfied overall and reported more communication problems.11 There may also be differences in how physicians care for Latino patients, and this may affect their satisfaction and future health care use. Todd et al. reported that Hispanics with isolated long-bone fractures were twice as likely as non-Hispanic whites to receive no pain medication in an emergency department.12 Latinos with limited English proficiency may also be less likely to receive follow-up appointments after an initial physician visit because of discrimination, communication barriers leading to misdiagnosis or lack of awareness of a problem, or even physician frustration over difficulty communicating. To our knowledge, no study has investigated the effects of limited English proficiency or communicating through an interpreter on physician referral patterns. Finally, Latinos with limited English proficiency might be less likely to comply with referral appointments because of dissatisfaction, or poor understanding of the reason for the referral, or simply because they are unaware that they are supposed to have a follow-up appointment. Manson found that asthmatic patients receiving extended follow-up care in an ambulatory care setting from a language-discordant physician were more likely to miss office appointments than were patients with a language-concordant physician.13 To further examine these issues, we conducted this study to determine the association between language barriers and (1) rates of referral for a follow-up appointment after an emergency department visit, (2) patients' knowledge that an appointment had been scheduled, and (3) actual compliance with scheduled follow-up appointments.

199 citations

Journal ArticleDOI
TL;DR: It follows that a high incidence of amputation can reflect a higher disease prevalence, late referral, limited resources, or a particularly interventionist approach by a specialist team, while a low incidence can indicate a lower disease prevalence or severity, good management of diabetes in primary and secondary care, and a particularly conservative approach by an expert team.
Abstract: Strategic targets for the management of foot ulcers focus on reducing the incidence of amputation. While data on the incidence of amputation can be obtained relatively easily, the figures require very careful interpretation. Variation in the definition of amputation, population selection and the choice of numerator and denominator make comparisons difficult. Major and minor amputation have to be distinguished as they are undertaken for different reasons and are associated with different costs and functional implications. Many factors influence the decision of whether or not to remove a limb. In addition to disease severity, co-morbidities, and social and individual patient factors, many aspects of the structure of care services affect this decision, including access to primary care, quality of primary care, delays in referral, availability and quality of specialist resources, and prevailing medical opinion. It follows that a high incidence of amputation can reflect a higher disease prevalence, late referral, limited resources, or a particularly interventionist approach by a specialist team. Conversely, a low incidence of amputation can indicate a lower disease prevalence or severity, good management of diabetes in primary and secondary care, or a particularly conservative approach by an expert team. An inappropriately conservative approach could conceivably enhance suffering by condemning a person to months of incapacity before they die with an unhealed ulcer. The reported annual incidence of major amputation in industrialised countries ranges from 0.06 to 3.83 per 103 people at risk. Some centres have documented that the incidence is falling, but this is often from a baseline value that was unusually high. Other centres have reported that the incidence has not changed. The ultimate target is to achieve not only a decrease in incidence, but also a low overall incidence. This must be accompanied by improvements in morbidity, mortality, and patient function and mood.

199 citations

Journal ArticleDOI
TL;DR: A higher rate of attributable mortality in patients who were refused intensive care is found, particularly for emergency cases, and it is concluded that there is an urgent need for more appropriate admission and discharge criteria.

199 citations


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Performance
Metrics
No. of papers in the topic in previous years
YearPapers
20251
20242
20233,272
20226,893
20211,905
20201,749