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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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TL;DR: The most common reason cited for dropping out of the rehabilitation program was work, followed by financial reasons and lack of motivation or commitment, which is a common set of barriers many patients currently face to begin and continue participating in outpatient cardiac rehabilitation.
Abstract: BACKGROUND A significant proportion of eligible patients do not participate in outpatient cardiac rehabilitation. The purpose of this study was to identify barriers to participation and adherence to outpatient cardiac rehabilitation by querying program staff. METHODS In January 1999, a survey was mailed to all North Carolina program directors of outpatient cardiac rehabilitation programs. The response rate was 85% (61/72). RESULTS Across programs, the most common barrier to participation in outpatient cardiac rehabilitation was financial. Other barriers identified by program directors included lack of patient motivation, patient work or time conflicts, and lack of physician support or referral. When program directors were asked to cite reasons that referred patients provided for not participating in rehabilitation, the most common answer was financial or lack of motivation or commitment. The most common reason cited for dropping out of the rehabilitation program was work, followed by financial reasons and lack of motivation or commitment. CONCLUSIONS The results of this statewide survey of program directors indicated a common set of barriers that many patients currently face to begin and continue participating in outpatient cardiac rehabilitation.

157 citations

Journal ArticleDOI
TL;DR: The US Substance Abuse and Mental Health Services Administration's Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program was adapted successfully to the needs of early identification efforts for hazardous use of alcohol and illicit drugs.
Abstract: Aims This paper describes the major findings and public health implications of a cross-site evaluation of a national Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program funded by the US Substance Abuse and Mental Health Services Administration (SAMHSA). Methods Eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the adoption and sustained implementation of SBIRT. The SBIRT cross-site evaluation used a multi-method evaluation design to provide comprehensive information on the processes, outcomes and costs of SBIRT as implemented in a variety of medical and community settings. Findings SBIRT programs in the two evaluated SAMHSA cohorts screened more than 1 million patients/clients. SBIRT implementation was facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Although the quasi-experimental nature of the outcome evaluation does not permit causal inferences, pre–post differences were clinically meaningful and statistically significant for almost every measure of substance use. Greater intervention intensity was associated with larger decreases in substance use. Both brief intervention and brief treatment were associated with positive outcomes, but brief intervention was more cost-effective for most substances. Sixty-nine (67%) of the original performance sites adapted and redesigned SBIRT service delivery after initial grant funding ended. Four factors influenced SBIRT sustainability: presence of program champions, availability of funding, systemic change and effective management of SBIRT provider challenges. Conclusions The US Substance Abuse and Mental Health Services Administration's Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program was adapted successfully to the needs of early identification efforts for hazardous use of alcohol and illicit drugs. SBIRT is an innovative way to integrate the management of substance use disorders into primary care and general medicine. Screening, Brief Intervention and Referral to Treatment implementation was associated with improvements in treatment system equity, efficiency and economy.

157 citations

Journal ArticleDOI
TL;DR: Hospital-based physician network structure has a significant relationship with an institution’s care patterns for their patients, and hospitals with primary care-centered networks have lower costs and care intensity.
Abstract: Background:There is substantial variation in the cost and intensity of care delivered by US hospitals. We assessed how the structure of patient-sharing networks of physicians affiliated with hospitals might contribute to this variation. Methods:We constructed hospital-based professional networks based on patient-sharing ties among 61,461 physicians affiliated with 528 hospitals in 51 hospital referral regions in the US using Medicare data on clinical encounters during 2006. We estimated linear regression models to assess the relationship between measures of hospital network structure and hospital measures of spending and care intensity in the last 2 years of life. Results:The typical physician in an average-sized urban hospital was connected to 187 other doctors for every 100 Medicare patients shared with other doctors. For the average-sized urban hospital an increase of 1 standard deviation (SD) in the median number of connections per physician was associated with a 17.8% increase in total spending, in addition to 17.4% more hospital days, and 23.8% more physician visits (allP< 0.001). In addition, higher “centrality” of primary care providers within these hospital networks was associated with 14.7% fewer medical specialist visits (P< 0.001) and lower spending on imaging and tests (!9.2% and!12.9% for 1 SD increase in centrality,P< 0.001). Conclusions:Hospital-based physician network structure has a significant relationship with an institution’s care patterns for their patients. Hospitals with doctors who have higher numbers of connections have higher costs and more intensive care, and hospitals with primary carecentered networks have lower costs and care intensity.

156 citations

Journal ArticleDOI
TL;DR: Findings suggest that factors are operating during a first episode of psychosis to increase the risk that the pathway to care for Black patients will involve non-health professionals.
Abstract: Background Previous research has found that African–Caribbean and Black African patients are likely to come into contact with mental health services via more negative routes, when compared with White patients. We soughtto investigate pathways to mental health care and ethnicityin a sample of patients with a first episode of psychosis drawn from two UK centres. Method We included all White British, other White, African–Caribbean and Black African patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes. Results Compared with White British patients, general practitioner referral was less frequent for both African–Caribbean and Black African patients and referral by a criminal justice agency was more common. With the exception of criminal justice referrals for Black African patients, these findings remained significant after adjusting for potential confounders. Conclusions These findings suggest that factors are operating during a first episode of psychosis to increase the risk that the pathway to care for Black patients will involve non-health professionals.

156 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