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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: To write a narrative review of the roles of primary care practitioners in caring for people with dementia in the community, primary care nurses and midwives were asked to provide a history of the practice and recommend improvements.
Abstract: Objectives To write a narrative review of the roles of primary care practitioners in caring for people with dementia in the community.Methods The systematic review carried out for the NICE/SCIE Guidelines was updated from January 2006, Cochrane Reviews were identified, and other publications found by consultation with experts.Results The insidious and very variable development of dementia syndromes makes recognition of the syndrome problematic in primary care. Dementia is probably under-diagnosed and under treated with an estimated 50% of primary care patients over 65 not diagnosed by their primary care physicians. This problem of under-diagnosis is probably not due to lack of diagnostic skills, but rather to the interaction of case-complexity, pressure on time and the negative effects of reimbursement systems. Primary care physicians often over-estimate the prevalence of dementia syndromes, but in some countries may also overestimate the prevalence of vascular dementia compared with Alzheimer's disease. Diagnosis is a step-wise process which can be aided by use of a cognitive function test, of which there are a number suitable for primary care use. Evidence based practice protocols can enhance detection rates in primary care, and there is growing evidence that communication skills in talking to people with dementia about dementia can be improved. Nevertheless there are multiple obstacles to bringing recognition forward in time, both in public awareness and professional understanding of the early changes in dementia.Conclusions There is insufficient evidence of benefit to justify population screening in primary care but earlier recognition of people with dementia syndrome is possible within primary care. The diagnosis of dementia is a shared responsibility between generalist and specialist disciplines. Primary care physicians should explore patients' ideas and concerns around their symptoms prior to referral and tentatively discuss possible diagnoses. Once the diagnosis has been confirmed, the primary care physician should provide both practical and emotional support to allow the patient and their family to come to terms with living with dementia, and refer them for additional psychosocial support if required. Copyright (C) 2009 John Wiley & Sons, Ltd.

188 citations

Journal ArticleDOI
01 Dec 2012-Spine
TL;DR: Early physical therapy following a new primary care consultation for low back pain was associated with reduced risk of subsequent health care compared with delayed physical therapy and physical therapy content showed weaker associations with subsequent care.
Abstract: Study design A retrospective cohort. Objective To describe physical therapy utilization following primary care consultation for low back pain (LBP) and evaluate associations between the timing and content of physical therapy and subsequent health care utilization and costs. Summary of background data Primary care management of LBP is highly variable and the implications for subsequent costs are not well understood. The importance of referring patients from primary care to physical therapy has been debated, and information on how the timing and content of physical therapy impact subsequent costs and utilization is needed. Methods Data were extracted from a national database of employer-sponsored health plans. A total of 32,070 patients with a new primary care LBP consultation were identified and categorized on the basis of the use of physical therapy within 90 days. Patients utilizing physical therapy were further categorized based on timing (early [within 14 d] or delayed)] and content (guideline adherent or nonadherent). LBP-related health care costs and utilization in the 18-months following primary care consultation were examined. Results Physical therapy utilization was 7.0% with significant geographic variability. Early physical therapy timing was associated with decreased risk of advanced imaging (odds ratio [OR] = 0.34, 95% confidence interval [CI]: 0.29, 0.41), additional physician visits (OR = 0.26, 95% CI: 0.21, 0.32), surgery (OR = 0.45, 95% CI: 0.32, 0.64), injections (OR = 0.42, 95% CI: 0.32, 0.64), and opioid medications (OR = 0.78, 95% CI: 0.66, 0.93) compared with delayed physical therapy. Total medical costs for LBP were $2736.23 lower (95% CI: 1810.67, 3661.78) for patients receiving early physical therapy. Physical therapy content showed weaker associations with subsequent care. Conclusion Early physical therapy following a new primary care consultation was associated with reduced risk of subsequent health care compared with delayed physical therapy. Further research is needed to clarify exactly which patients with LBP should be referred to physical therapy; however, if referral is to be made, delaying the initiation of physical therapy may increase risk for additional health care consumption and costs.

187 citations

Journal ArticleDOI
TL;DR: In this paper, a simple model of multiple referral under open rule is presented, where an uninformed House multiply refers legislation to two specialist committees (experts) who have policy preferences, analytically equivalent to speeches giving advice to the House about what policy to choose.

187 citations

Journal Article
TL;DR: This article analyzed the patterns and determinants of student progression through sequences of developmental education starting from initial referral and found that fewer than one half of the students who are referred to remediation actually complete the entire sequence to which they are referred.
Abstract: After being assessed, many students entering community colleges are referred to one or more levels of developmental education. While the need to assist students with weak academic skills is well known, little research has examined student progression through multiple levels of developmental education and into entry-level college courses. The purpose of this paper is to analyze the patterns and determinants of student progression through sequences of developmental education starting from initial referral. Our results indicate that fewer than one half of the students who are referred to remediation actually complete the entire sequence to which they are referred. About 30 percent of students referred to developmental education do not enroll in any remedial course, and only about 60 percent of referred students actually enroll in the remedial course to which they were referred. The results also show that more students exit their developmental sequences because they did not enroll in the first or a subsequent course than because they failed or withdrew from a course in which they were enrolled. We also show that men, older students, African American students, part-time students, and students in vocational programs are less likely to progress through their full remedial sequences.

187 citations

Journal ArticleDOI
18 Apr 1986-JAMA
TL;DR: Primary care physicians have not been very successful at diagnosing and treating substance abuse and mental disorders because of inadequate training, patients' attitudes, and the constraints of the health care system.
Abstract: Millions of Americans suffer and die of alcohol abuse, other drug abuse, and mental disorders that go undiagnosed and untreated. Studies showing that up to 19% of the US adult population have these disorders also have found that only one fifth of those affected have sought help for them in the previous six months. Many of these persons have disorders that are treatable with modern medications and therapy. Because more than half of all persons with these disorders obtain all of their care from the general medical sector, a great potential exists in primary care for prevention, detection, treatment, and referral of these patients. Primary care physicians, however, have not been very successful at diagnosing and treating substance abuse and mental disorders because of inadequate training, patients' attitudes, and the constraints of the health care system. Recommendations to improve this situation include continued research, improved physician education, and increased emphasis on care of these disorders by organized medicine. Although tobacco use is also a major health problem, data relating to nicotine addiction were not included in this report. ( JAMA 1986;255:2054-2057)

187 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