Referral

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

Rethinking prevention in primary care: applying the chronic care model to address health risk behaviors.

Abstract: This study examines the Chronic Care Model (CCM) as a framework for preventing health risk behaviors such as tobacco use, risky drinking, unhealthy dietary patterns, and physical inactivity. Data were obtained from primary care practices participating in a national health promotion initiative sponsored by the Robert Wood Johnson Foundation. Practices owned by a hospital health system and exhibiting a culture of quality improvement were more likely to offer recommended services such as health risk assessment, behavioral counseling, and referral to community-based programs. Practices that had a multispecialty physician staff and staff dieticians, decision support in the form of point-of-care reminders and clinical staff meetings, and clinical information systems such as electronic medical records were also more likely to offer recommended services. Adaptation of the CCM for preventive purposes may offer a useful framework for addressing important health risk behaviors.

The Pediatric Primary-Specialty Care Interface How Pediatricians Refer Children and Adolescents to Specialty Care

Abstract: Objective: To describe how pediatricians refer patients to specialists, including frequency of referral decisions, reasons for referral, and types of referrals. Design: We conducted a prospective study of visits (N = 58 771) made to 142 pediatricians in a national primary care practice‐based research network. During 20 consecutive practice days, physicians and parents completed questionnaires for referred patients, and office staff kept logs of all visits. Physicians used medical records to complete questionnaires 3 months after referrals were made. Results: Pediatricians referred patients to specialists during 2.3% of office visits. Referrals made during telephone conversations with parents accounted for 27.5% of all referrals. The most common reason for referral was advice on diagnosis or treatment (74.3%). Referrals were made most commonly to surgical subspecialists (52.3%), followed by medical subspecialists (27.9%), nonphysicians (11.4%), and mental health practitioners (8.4%). Physicians requested a consultation or a referral with shared management in 75% of cases. Otitis media was the condition referred most often (9.2%). Fifty other conditions accounted for 84.3% of all referrals. Conclusions: About 1 in 40 pediatric visits result in referral. Getting advice from a specialist is the most common reason for referral. Pediatricians desire a collaborative relationship with specialists for most of their referred patients. Physician training to increase clinical competence may be most useful for the 50 most commonly referred conditions. Education concerning the referral process should focus on the respective roles of the referring physician and specialist, particularly as they pertain to successful approaches for comanaging referred patients. Arch Pediatr Adolesc Med. 1999;153:705-714

Pain treatment and outcomes for patients with advanced cancer who receive follow-up care at home

Abstract: BACKGROUND A small sample size, a high rate of exclusions, inadequate follow-up in different settings, and a lack of comparison with previous levels of analgesia have recently been reported to be the principal limitations of the World Health Organization (WHO) guidelines regarding cancer pain. METHODS A total of 3678 consecutive patients with advanced cancer referred to a home palliative care program were enrolled in an open prospective study over a 9-year period, from June 1988 to June 1997, to determine the effectiveness, safety, and feasibility of implementing the WHO guidelines. Age, gender, Eastern Cooperative Oncology Group performance status, pain mechanism at referral, pain and symptom intensity, and doses and days of drug administration during the course of the treatment were recorded at regular intervals. RESULTS Therapy was required for 70.3% of patients for a mean duration of 64 days. The mean duration periods of the 3 steps were 18, 27, and 19 days, respectively. At referral, most patients received inadequate treatment. In the last week of life, 16%, 49%, and 35% of patients were taking nonopioid drugs, moderate opioids, and strong opioids, respectively. A significant improvement in pain and symptom intensity was achieved after referral. Symptom intensity worsened in the last week of life. A minority of patients (2.65%) underwent invasive procedures. CONCLUSIONS This study demonstrates that a managed home care system enables patients to receive adequate pain treatment, according to WHO guidelines, in the comfort of their own homes. [See editorial on pages 1645–8, this issue.] Cancer 1999;85:1849–58. © 1999 American Cancer Society.

Assessment, management, and prevention of early childhood caries.

Abstract: Purpose: To discuss the role of primary care health providers in identifying infants and young children at risk for dental caries during well-child visits, in providing anticipatory guidance to parents and primary care givers of at-risk children, and in providing appropriate referrals for the timely establishment of a dental home. Data sources: The search included the following: Ovid MEDLINE, PubMed, American Academy of Pediatrics Web site, American Academy of Pediatric Dentistry Web site, and the American Dental Association Web site. The following search terms were used: dental caries prevention, caries process, caries balance, dental home, early childhood caries, oral health disparities, dental caries risk assessment, fluoride varnish, oral health anticipatory guidance. Search was limited to English language sources from 1990 through 2007. Conclusions: Dental caries is a preventable and reversible infectious disease process, yet it continues to be the single most common chronic disease of childhood. Despite a decrease in caries prevalence and a decrease in untreated tooth decay in 6–19-year-olds in the United States, a 15.2% increase in disease was noted among the nation’s youngest children aged 2–5 years. Primary care health providers are uniquely positioned to play a significant role in the prevention of dental caries and are encouraged to complete certification courses in caries risk assessment, intervention, education, and referral. Implications for practice: Clinicians need to understand the dental caries process, including the process of enamel demineralization and remineralization, and the factors contributing to caries balance. The importance of early identification and intervention for infants and toddlers at high risk for dental caries and primary care health provider-delivered anticipatory guidance during well-child care visits cannot be overestimated.

Help Seeking for Mental Health Problems Among Mexican Americans

Abstract: This study uses data from a household survey (Mexican American Prevalence and Services Study; MAPSS) of 3,000 respondents in Fresno County, California, to 1) contrast use across multiple sectors of care among immigrant and US born Mexican Americans with recent psychiatric disorders, 2) contrast multiple provider utilization patterns, and 3) identify specific factors associated with the use of mental health specialty and general medical sectors Immigrants and US born disproportionately used the general medical sector for treating mental health problems The US born were more likely to use family physicians and counselors than were immigrants, and neither relied heavily upon informal network providers to treat psychiatric disorders A comparison of patterns showed that most people with a recent disorder used a combination of providers The logistic regression analyses showed that knowing where to find a provider increased the likelihood of specialty mental health use by an odds ratio (OR) of 468 Private insurance increased use of mental health providers, OR = 376 Public insurance availability did not increase mental health provider use, suggesting that other factors were linked to use of mental health specialty care Public insurance did increase medical sector care for psychiatric problems, OR = 257 Poor self-rated mental health status was primarily associated with use of physicians by US born (OR = 539) Severe mental health impairment increased use of both general medical (OR = 554) and specialty mental health (OR = 51) providers These results point out that eligibility for public insurance is a necessary but not sufficient status to increase mental health sector care among immigrants, and education and more effective referral from other sectors are needed to encourage use of these services