scholarly journals The effects of audit and feedback and electronic referrals on the quality of primary care referral letters

2014 ◽  
Vol 6 (4) ◽  
pp. 324 ◽  
Author(s):  
Paul Corwin ◽  
Tim Bolter
Keyword(s):  
Primary Care ◽  
General Practice ◽  
General Practitioners ◽  
West Coast ◽  
Secondary Care ◽  
Referral Letter ◽  
The West ◽  
Electronic Referral ◽  
Referral Letters

INTRODUCTION: Appropriate referral from primary care to hospital specialists is a critical component of general practice patient management. This study investigated the quality of such referrals in a group of general practitioners (GPs) and nurses. AIM: To assess whether feedback improves the quality of referral letters from general practice to secondary care and how electronic referrals affect the quality of referral letters. METHODS: All 15 GPs working on the West Coast in New Zealand and the two nurses in this locality who regularly wrote referral letters agreed to participate in the study. For each participant, referral letters to hospital specialists were assessed using a nine-point checklist. Ten consecutive letters were assessed for each participant. Written feedback on referral letter quality was given and a further 10 letters from each participant were assessed five months later. After a further five months, 10 electronic referral letters from each participant were assessed. RESULTS: Feedback to general practitioners and nurses improved the quality of referral letters for participants whose original referral letters were of poorer quality. The average score for referral letters was 81.4% at baseline and this improved to 86.9% after feedback. The introduction of electronic referral letters did not lead to a further improvement in referral letter quality. DISCUSSION: This study demonstrated that feedback to general practitioners and nurses can improve the quality of referral letters to secondary care. The introduction of electronic referral letters as used on the West Coast did not lead to any further improvement in referral quality. KEYWORDS: Hospital referrals; primary health care; quality improvement

Do rhinology care pathways in primary care influence the quality of referrals to secondary care?

2013 ◽  
Vol 127 (4) ◽  
pp. 364-367 ◽  
Author(s):  
N Su ◽  
P P Cheang ◽  
H Khalil
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Secondary Care ◽  
Evidence Based ◽  
Care Pathways ◽  
Diagnosis And Management ◽  
Care Guidelines ◽  
Evidence Based Guidelines ◽  
Referral Letters

AbstractBackground:Chronic sinusitis is the most common routine presentation for a general ENT surgeon. The 2007 ‘Primary Care Guidelines: European Position Paper on the Primary Care Diagnosis and Management of Rhinosinusitis and Nasal Polyps’ aimed to deliver evidence-based guidelines for the diagnosis and management of rhinosinusitis in specialist and primary care.Objective:The aim of this audit was to assess the information provided in the referral letters to the ENT department regarding patients with potential rhinosinusitis, and compare this to the information required for the rhinology care pathways.Method:We evaluated one month of referrals to the ENT department.Results:The quality of information in the referral letters was poor. Only 22 per cent of patient referrals included basic information about symptoms, duration and treatment.Conclusion:We plan to investigate why general practitioners are not complying with the pathway. In addition, the pathways will be more widely disseminated via the ‘Map of Medicine’ (an online resource for general practitioners). This should facilitate the receipt of the best evidence-based treatment for patients prior to referral to secondary care.

scholarly journals Clinical and healthcare improvement through My Health Record usage and education in general practice (CHIME-GP): a study protocol for a cluster-randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Andrew Bonney ◽  
Christine Metusela ◽  
Judy Mullan ◽  
Stephen Barnett ◽  
Joel Rhee ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
General Practitioners ◽  
Educational Intervention ◽  
Health Record ◽  
Post Intervention ◽  
Rational Use ◽  
Cluster Randomised ◽  
Test Ordering

Abstract Background There is an international interest in whether improved primary care can lead to a more rational use of health resources. There is evidence that educational interventions can lead to improvements in the quality of rational prescribing and test ordering. A new national platform for shared medical records in Australia, My Health Record (MHR), poses new opportunities and challenges for system-wide implementation. This trial (CHIME-GP) will investigate whether components of a multifaceted education intervention in an Australian general practice setting on rational prescribing and investigation ordering leads to reductions in health-service utilisation and costs in the context of the use of a national digital health record system. Methods The trial will be undertaken in Australian general practices. The aim of the research is to evaluate the effectiveness of components of a web-based educational intervention for general practitioners, regarding rational use of medicines, pathology and imaging in the context of the use of the MHR system. Our target is to recruit 120 general practitioners from urban and regional regions across Australia. We will use a mixed methods approach incorporating a three-arm pragmatic cluster randomised parallel trial and a prospective qualitative inquiry. The effect of each education component in each arm will be assessed, using the other two arms as controls. The evaluation will synthesise the results embedding qualitative pre/post interviews in the quantitative results to investigate implementation of the intervention, clinical behaviour change and mechanisms such as attitudes, that may influence change. The primary outcome will be an economic analysis of the cost per 100 consultations of selected prescriptions, pathology and radiology test ordering in the 6 months following the intervention compared with 6 months prior to the intervention. Secondary outcome measures include the rates per 100 consultations of selected prescriptions, pathology and radiology test ordering 6 months pre- and post-intervention, and comparison of knowledge assessment tests pre- and post-intervention. Discussion The trial will produce robust health economic analyses on the evidence on educational intervention in reducing unnecessary prescribing, pathology and imaging ordering, in the context of MHR. In addition, the study will contribute to the evidence-base concerning the implementation of interventions to improve the quality of care in primary care practice. Trial registration ClinicalTrials.gov ACTRN12620000010998. Registered on 09 January 2020 with the Australian New Zealand Clinical Trials Registry

scholarly journals Mental Illness in Primary Care Settings

1985 ◽  
Vol 9 (1) ◽  
pp. 12-13 ◽  
Author(s):  
Greg Wilkinson
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
General Practice ◽  
Social Security ◽  
General Practitioners ◽  
Research Unit ◽  
Practice Research ◽  
Policy Makers ◽  
Department Of Health ◽  
Primary Care Settings

A Conference on the above topic took place at the Institute of Psychiatry, London, on 17 and 18 July 1984. The Conference was sponsored by the Department of Health and Social Security and was organized by the General Practice Research Unit. Over 100 invited clinicians, research workers and policy-makers took part. The majority of the participants were either psychiatrists or general practitioners, but representatives of all relevant disciplines attended.

Recognition of and Response to Dementia Syndrome in Primary Care: Part 1

2009 ◽  
Vol 2 (4) ◽  
pp. 230-236 ◽  
Author(s):  
Steve Iliffe ◽  
Priya Jain ◽  
Jane Wilcock
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Cognitive Function ◽  
General Practitioners ◽  
Function Tests ◽  
Dementia Syndrome

The theme of this article is the recognition of and response to dementia in general practice. Its aim is to clarify the tasks of diagnosing dementia, to advise on the use of cognitive function tests, to suggest ways of establishing the subtype of dementia where possible and to assist general practitioners in talking about dementia with their patients and their families.

Evaluation of a brief psychological treatment for emotional disorders in primary care

1991 ◽  
Vol 21 (4) ◽  
pp. 1013-1018 ◽  
Author(s):  
J. Catalan ◽  
D. H. Gath ◽  
P. Anastasiades ◽  
S. A. K. Bond ◽  
A. Day ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Problem Solving ◽  
Randomized Trial ◽  
Emotional Disorders ◽  
General Practitioners ◽  
Poor Prognosis ◽  
Psychological Treatment ◽  
Recent Onset

SYNOPSISA randomized trial in general practice compared: (i) a brief psychological treatment (problem-solving) given by a psychiatrist; (ii) any treatment of the GP's choice, whether psychological or pharmacological. The patients had recent onset emotional disorders of poor prognosis. Patients in the problem-solving group showed significantly greater reductions in symptoms. Problem-solving as given by a psychiatrist was feasible in primary care and acceptable to patients. Problem-solving is now being evaluated as given by general practitioners trained in the method.

scholarly journals The SOFIA pilot trial: a cluster-randomized trial of coordinated, co-produced care to reduce mortality and improve quality of life in people with severe mental illness in the general practice setting

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
M. P. Rozing ◽  
A. Jønsson ◽  
R. Køster-Rasmussen ◽  
T. D. Due ◽  
J. Brodersen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Illness ◽  
General Practice ◽  
Severe Mental Illness ◽  
General Practitioners ◽  
Pilot Trial ◽  
Care Program ◽  
Coordinated Care ◽  
Educational Training

Abstract Background People with severe mental illness (SMI) have an increased risk of premature mortality, predominantly due to somatic health conditions. Evidence indicates that primary and tertiary prevention and improved treatment of somatic conditions in patients with SMI could reduce this excess mortality. This paper reports a protocol designed to evaluate the feasibility of a coordinated co-produced care program (SOFIA model, a Danish acronym for Severe Mental Illness and Physical Health in General Practice) in the general practice setting to reduce mortality and improve quality of life in patients with severe mental illness. Methods The SOFIA pilot trial is designed as a cluster randomized controlled trial targeting general practices in two regions in Denmark. We aim to include 12 practices, each of which is instructed to recruit up to 15 community-dwelling patients aged 18 and older with SMI. Practices will be randomized by a computer in a ratio of 2:1 to deliver a coordinated care program or usual care during a 6-month study period. A randomized algorithm is used to perform randomization. The coordinated care program includes educational training of general practitioners and their clinical staff educational training of general practitioners and their clinical staff, which covers clinical and diagnostic management and focus on patient-centered care of this patient group, after which general practitioners will provide a prolonged consultation focusing on individual needs and preferences of the patient with SMI and a follow-up plan if indicated. The outcomes will be parameters of the feasibility of the intervention and trial methods and will be assessed quantitatively and qualitatively. Assessments of the outcome parameters will be administered at baseline, throughout, and at end of the study period. Discussion If necessary the intervention will be revised based on results from this study. If delivery of the intervention, either in its current form or after revision, is considered feasible, a future, definitive trial to determine the effectiveness of the intervention in reducing mortality and improving quality of life in patients with SMI can take place. Successful implementation of the intervention would imply preliminary promise for addressing health inequities in patients with SMI. Trial registration The trial was registered in Clinical Trials as of November 5, 2020, with registration number NCT04618250. Protocol version: January 22, 2021; original version

Problems affecting the pinna

2020 ◽  
Vol 13 (12) ◽  
pp. 717-721
Author(s):  
Charlotte Juman ◽  
Navdeep Singh Bhamra ◽  
Karan Jolly
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Secondary Care ◽  
Diagnosis And Management

The presentation of problems relating to the ears is common in general practice. This article considers common and significant presentations encountered in primary care including assessment, diagnosis and management of patients with guidance on when to refer to secondary care.

Work Stress and Quality of Work Performance in Australian General Practitioners

2002 ◽  
Vol 8 (2) ◽  
pp. 59 ◽  
Author(s):  
Helen R. Winefield ◽  
Bronwyn M. Veale
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Work Stress ◽  
Work Performance ◽  
Stress Indicators ◽  
Response Biases ◽  
Work Supports ◽  
The Relationship ◽  
Level Analysis

The relationship between work stress and work performance has received little empirical attention in professional areas such as health care where measurement of work quality is difficult. In health sciences there is growing concern about work errors, although little is known about the determinants and prevention of these in primary care. This study aimed to explore connections between workload, work stress in terms of burnout, job satisfaction and retirement age intentions, and reported mistakes at work, in general practice. A randomly-selected sample of mid-career General Practitioners (aged 35-45 years) was approached and 86% agreed to participate (N = 30). Satisfaction with work supports was a better predictor of work stress indicators than was workload. There was no evidence of the hypothesised association between work stress and severity of mistakes. Although response biases are a likely threat to the validity of mistakes as a quality indicator, results can be seen as supporting the need for a systems-level analysis of primary care work performance.

How general practitioners treat migraine patients—evaluation of a headache guideline

Cephalalgia ◽  
2012 ◽  
Vol 32 (12) ◽  
pp. 908-915 ◽  
Author(s):  
R Zielman ◽  
PJL Veenstra ◽  
EW van Zwet ◽  
JSP van den Berg
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Pharmacological Treatment ◽  
Care Setting ◽  
Primary Care Setting ◽  
Referral Letter ◽  
Hospital Record ◽  
Specific Medication ◽  
History Of ◽  
First Time

Aim: The aim of the study was to evaluate the pharmacological treatment of migraine patients by general practitioners before referral to a neurologist. First, was the pharmacological treatment in accordance with the Dutch College of General Practitioners headache guideline? Second, which migraine characteristics were associated with receiving migraine-specific medication? Methods: Migraine patients (age ≥18 years) who visited the neurology outpatient clinic for the first time were included. Migraine characteristics and pharmacological status were collected retrospectively for each patient from the general practitioner’s referral letter, hospital record and a headache characteristics questionnaire. Results: A total of 420 migraine patients were included. Only 18.3% of the patients with two or more migraine attacks per month were using prophylactic medication. Furthermore, only 11.7% of patients with symptoms of nausea and/or vomiting were using anti-emetic medication. More than half of patients (51.7%) were using triptans and were likely to have typical migraine symptoms and a long history of migraine. Conclusions: Migraine prophylactic medication and anti-emetics are underutilized in the primary care setting for migraine patients in the Netherlands, when compared to the general practitioners guideline. It is important to enhance the knowledge of general practitioners regarding the diagnosis of migraine, and to increase awareness of the headache guideline.

Sign in / Sign up

Export Citation Format

Share Document