Referral

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

Is early diagnosis of oral cancer a feasible objective? Who is to blame for diagnostic delay?

Abstract: Worldwide, oral cancer has one of the lowest survival rates and poor prognosis remains unaffected despite recent therapeutic advances. Reducing diagnostic delay to achieve earlier detection is a cornerstone to improve survival. Thus, intervention strategies to minimize diagnostic delays resulting from patient factors and to identify groups at risk in different geographical areas seem to be necessary. The identification of a 'scheduling delay' in oral cancer justifies the introduction of additional educational interventions aimed at the whole health care team at dental and medical practices. The access to and the kind of healthcare system in a particular country are also relevant in this context, particularly the referral system. The design of a simple, clear, fail-safe, fast-track referral scheme for those suspected with cancer may diminish greatly the length of the delay. Moreover, there is a need for future investigations, which are methodologically adequate, that consider cultural and geographical aspects and use patient survival as the final outcome, that are able to recognize the agents/factors responsible for diagnostic delay by patients as well as healthcare providers and those attributable to the healthcare systems.

Prevention of early childhood caries in North Carolina medical practices: implications for research and practice.

Abstract: Early childhood caries is a significant public health problem in low-income children, with important negative consequences for the child and the family. The purpose of this paper is to describe the development, implementation, and preliminary outcomes of preventive dentistry programs in North Carolina that target low-income children from birth to thirty-five months of age. The focus is on Into the Mouths of Babes, a statewide program in which pediatricians, family physicians, and providers in community health clinics are reimbursed by Medicaid to provide preventive dental services for children (risk assessment, screening, referral, fluoride varnish application) and caregivers (counseling). The provider intervention includes continuing medical education lectures and interactive sessions, practice guidelines for the patient interventions, case-based problems, practical strategies for implementation, a toolkit with resource materials, and follow-up training. In the first two years of the statewide program, 1,595 medical providers have been trained. The number of providers billing for these services has steadily increased, and by the last quarter of 2002, the number of visits in which preventive dental services were provided in medical offices reached 10,875. A total of 38,056 preventive dental visits occurred in medical offices in 2002. By the end of 2002, only sixteen of the state9s one hundred counties had no pediatrician, family physician, or local health department participating. The preliminary results from this program demonstrate that nondental professionals can integrate preventive dental services into their practices. The program has increased access to preventive dental services for young Medicaid children whose access to dentists is restricted. Assessments of effectiveness and cost-effectiveness of both the provider and patient interventions are under way.

School Refusal in Children and Adolescents

Abstract: School refusal is a problem that is stressful for children, families, and school personnel. Failing to attend school has significant short- and long-term effects on children's social, emotional, and educational development. School refusal often is associated with comorbid psychiatric disorders such as anxiety and depression. It is important to identify problems early and provide appropriate interventions to prevent further difficulties. Assessment and management of school refusal require a collaborative approach that includes the family physician, school staff, parents, and a mental health professional. Because children often present with physical symptoms, evaluation by a physician is important to rule out any underlying medical problems. Treatments include educational-support therapy, cognitive behavior therapy, parent-teacher interventions, and pharmacotherapy. Family physicians may provide psychoeducational support for the child and parents, monitor medications, and help with referral to more intensive psychotherapy.

Transitional care of older adults.

Abstract: This chapter reviews 94 published research reports on transitional care of older adults by nurse researchers and researchers from other disciplines. Reports were identified through searches of MEDLINE, CINAHL, HealthSTAR, Sociological Abstracts and PsycINFO using combinations of the following search terms: transitional care, discharge planning, care coordination, case management, continuity of care, referrals, postdischarge follow-up, patient assessment, patient needs, interventions, and evaluation. Reports were included if published between 1985 and 2001, if conducted on samples age 55 and older, if relevant to nursing research, and if published in English. Intervention studies had to have a control or comparison group and a test for statistical significance. Four key findings from this review were identified. A high proportion of elders and their caregivers report substantial unmet transitional care needs, with the need for information and increased access to services consistently among the top priorities. Differences in expectations between and among patients, families, and health care providers, and the need for increased patient and family involvement in decision making, are common themes in discharge planning studies. Gaps in communication have been identified through the discharge planning process. Evidence about the effects of innovations in transitional care on quality and cost outcomes is sparse. Four main recommendations are made. Differences in older adults' transitional care needs based on race, ethnicity, and educational level, with attention to potential disparities, require further study. Studies of strategies to promote effective involvement of patients and families in decision making throughout discharge planning are needed. The development and testing of referral and other information systems designed to promote the transfer of accurate and complete information across sites of care should be a research focus. A priority for future research should be continued study of strategies to improve transitional care outcomes of older adults and their caregivers.

Offering Integrated Care for HIV/AIDS, Diabetes and Hypertension within Chronic Disease Clinics in Cambodia/Offre De Soins Integree a L'intention Des Personnes Vivant Avec le VIH/sida, Un Diabete Ou De L'hypertension Par Les Dispensaires Cambodgiens Specialises Dans Les Maladies Chroniques/ Atencion Integrada Contra El VIH/SIDA, la Diabetes Y la Hipertension En Dispensarios De Enfermedades Cronicas De Camboya

Abstract: Introduction At the end of 2004, there were an estimated 100 000 people living with HIV/ AIDS in Cambodia, of whom approximately 25 000 were estimated to urgently require care and treatment with highly active antiretroviral therapy (HAART). (1,2) Cambodia is struggling with a growing burden of chronic diseases. A survey done in 2005 estimated that between 5% and 11% of all adults had type II diabetes and the prevalence of impaired glucose intolerance was between 10% and 15%. The same survey showed that between 12% and 25% of the population screened could be classified as being hypertensive. (3) These results are consistent with growing evidence that diabetes and other non-communicable diseases represent a significant and growing part of the disease burden in low-income countries. (4,5) In 2002, Medecins Sans Frontieres (MSF) and the Cambodian Ministry of Health established chronic disease clinics to integrate HIV/AIDS care with the management of diabetes and hypertension in two provincial capitals, Takeo and Siem Reap. This paper describes the approach and outcomes of this strategy. Context Siem Reap and Takeo are both predominantly rural provinces, although the urban population of Siem Reap town is increasing rapidly due to growing tourism around the Angkor Wat temple complex. Both locations were selected for this pilot programme because they are large provincial centres with referral hospital capacity to expand activities. Furthermore, adequate care for the target diseases at these sites was lacking. HAART began to be provided in Cambodia in 2001. By the end of 2005, 12 355 people were on treatment through programmes run jointly by the Ministry of Health and nongovernmental organizations (NGOs). Chronic diseases are largely neglected in developing countries. (6) In Cambodia, medical care for diseases such as diabetes, arterial hypertension and epilepsy was not generally included in the reconstruction of the health care system over the past 15 years. Most diabetics receive only limited medication at referral hospital outpatient departments or when they arrive with severe hyperglycaemia at emergency wards; they are rarely referred to long-term care once they are discharged. Some drugs to treat arterial hypertension are available at hospitals and health centres, but these are usually provided for only two weeks. Rationale for the chronic disease clinics The rationale to combine care of HIV/ AIDS, diabetes and hypertension was based on three assumptions. First, the availability of antiretroviral treatment in developing countries is transforming HIV/AIDS into a chronic disease, as has been the experience elsewhere. (7) It was anticipated that in this resource-poor context, efficiency gains could be attained through the establishment of a multidisciplinary chronic disease care team that would use a common approach to respond to the needs of chronic disease patients, especially in providing continuity of care, long-term adherence support and social support. Second, in Cambodian society as elsewhere, the stigma attached to HIV/ AIDS presents a barrier to care. By providing care for seropositive clients and patients with other chronic diseases within the same facility, it was hoped that facility-related stigma could be reduced. Third, it was considered important that the care delivery model should reflect epidemiological realities. Although at the clinics' inception reliable epidemiological data on diabetes and other chronic diseases was lacking, these illnesses were recognized to contribute an increasing share of the total burden of disease in Cambodia. Diabetes was given a specific priority, since it was seen by many health workers as a frequent problem. The provision of systematic and continuous care for chronic diseases was encouraged by both the Ministry of Health and local WHO representatives, who were involved in the final design of this pilot health care delivery model. …