Deciphering the impact of responsiveness on customer satisfaction, cross-buying behaviour, revisit intention and referral behaviour

PurposeThe ease and convenience of online shopping are shifting the customers to e-tailers. This has prompted offline retailers to re-examine behavioural patterns along with a reconfiguration for a responsive retail model. The paper investigates the influence of responsiveness on customer satisfaction, cross-buying behaviour, revisit intention and referral behaviour.Design/methodology/approachData were collected via a survey answered by 793 fashion customers from India, and for data analysis, partial least square structural equation modelling (PLS-SEM) was employed. Path analysis was used to determine the interrelationships amongst the constructs used in the study.FindingsThe standardized path coefficients depict competitive responsiveness as the highest contributor of retailers' responsiveness followed by service responsiveness, employee responsiveness and customer responsiveness. The findings suggest that customer satisfaction acts as the biggest contributor to referral behaviour followed by cross-buying behaviour and revisit intentions.Originality/valueThis study has made a substantial contribution to fashion apparel retailing. The findings revealed that responsive retailing influences the customers' post-purchase behaviour as they engage in more cross-buying, revisiting and referral behaviour. The retailers are encouraged to carefully monitor their preparedness to deliver a combination of sensory, emotional, cognitive and social experience to their customers.

Does the implementation of a care pathway for patients with hip or knee osteoarthritis lead to fewer diagnostic imaging and referrals by general practitioners? A pre-post-implementation study of claims data

Background The Dutch care for hip and knee osteoarthritis (OA) is of good quality, but there is room for improvement regarding the efficient use of diagnostic imaging and conservative treatment. Therefore a stepped-care approach, in the shape of the care pathway ‘Better exercise in osteoarthritis’, was implemented to reduce the number of diagnostic imaging requested by GPs and referrals of GPs to orthopaedic care. Methods In 2015, the pathway is implemented with the use of educational meetings, distributing guidelines and incorporating reminders in the GPs’ referral application. To evaluate the effect of the pathway on the diagnostic and referral behaviour of GPs, hip and knee related health insurance claims are used together with claims of other joints and of a control region for comparison. The average number of claims and the percentage change in the post-implementation period are described. Binary logistic regression analysis is used to examine the interaction between region (intervention and control) and period (pre- and post-implementation). Using random sampling of patient records, information about the practical application of the pathway and the number of hip or knee arthroplasties is added. Results In both regions, the number of diagnostic imaging decreased and the number of initial orthopaedic consultations increased during the post-implementation period. Significant interaction effects were found in knee-related diagnostics (p ≤ 0.001) and diagnostics of other joints (p = 0.039). No significant interaction effects were found in hip-related diagnostics (p = 0.060) and in initial orthopaedic consultation claims of hip (p = 0.979), knee (p = 0.281), and other joints (p = 0.464). Being referred according to the pathway had no significant effect on the probability of undergoing arthroplasty. Conclusion The implementation of the pathway had a positive effect on GPs diagnostic behaviour related to the knee, but not to the hip. The referral behaviour of GPs to orthopaedic care needs attention for future interventions and research, since an increase (instead of a desired decrease) in the number of initial orthopaedic consultations was found. Focusing on the entire width of care for hip and knee OA could be helpful.

What factors influence healthcare professionals to refer children and families to paediatric psychology?

Objectives: This study aimed to investigate factors influencing referral of children with physical illness to paediatric psychology. Due to high rates of mental health problems within this population, studies have shown that referral to paediatric psychology should be increased. However, few studies have examined factors shaping healthcare professionals’ referral behaviour. Methods: This study used the theory of planned behaviour to develop a questionnaire which explores factors influencing the referral of children and families to paediatric psychology. Psychometric properties of the questionnaire were examined. Results: The questionnaire was found to have good reliability and validity. The main constructs of the theory of planned behaviour were useful in predicting intention to refer to paediatric psychology. Specific beliefs about referral were shown to influence intention to refer. Conclusion: Findings suggest that individual attitudes and beliefs can impact healthcare professionals’ referral behaviour, indicating that multidisciplinary interventions and inter-professional education relating to the psychological aspects of illness are required.

Distinguishing variation in referral accuracy from referral threshold: analysis of a national dataset of referrals for suspected cancer

ObjectivesTo distinguish between variation in referral threshold and variation in accurate selection of patients for referral in fast-track referrals for possible cancer. To examine factors associated with threshold and accuracy and model the effects of changing thresholds.DesignAnalysis of national data on cancer referrals from general practices in England over a 5-year period. We developed a new method to estimate specificity of referral to complement existing sensitivity. We used bivariate meta-analysis to produce summary measures and described practices in relation to these.Setting5479 general practitioner (GP) practices with data relating to more than 50 cancer cases diagnosed over the 5 years.OutcomesNumber of practices whose 95% confidence regions for sensitivity and specificity indicated that they were outliers in terms of either referral threshold or decision accuracy.Results2019 practices (36.8%) were outliers in relation to referral threshold compared with 1205 practices (22%) in relation to decision accuracy. Practice age profile, cancer incidence and deprivation showed a modest association with decision accuracy but not with thresholds. If all practices shared the referral behaviour of those in the highest quintile of age-standardised referral rate, there would be a 3.3% increase in cancers detected through fast-track pathways at the cost of a 36.9% increase in urgent referrals.ConclusionThis new method permits variation in referral to be described more precisely and quality improvement activities to be targeted. Changing referral thresholds without increasing accuracy will result in modest effects on detection rates and a large increase in demand on diagnostic services.

Theory of planned behaviour: general practitioners’ prescribing and referral behaviour

Rationale and aims: The vast majority of patients seen in general practice present with a mental health component to their illness. Despite current clinical guidelines, suggesting referral to psychological-based treatments being a more appropriate course of action, anti-depressant prescription remains high for those suffering common mental health problems (CMHPs). This study aimed to investigate General Practitioners’ (GPs) behaviour regarding the prescription of antidepressants and referral to psychological-based treatment for individuals with CMHPs, using the Theory of Planned Behaviour (TPB). Method: Online and postal questionnaires were developed in line with the TPB model following consultation, pilot study and cognitive debriefing. Questionnaires were distributed to all working GPs in Wales, UK. Data underwent statistical analysis.Results: Analysis of responses (n=127) showed a GP’s decision to prescribe antidepressants to patients with CMHPs is significantly influenced by both ‘attitude’ and ‘subjective norm’, while perceived behavioural control was non-significant. Over half of the study GPs did not feel in control of prescribing antidepressants to those with CMHPs. GPs’ intention to refer for psychological-based treatment was significantly influenced by attitude, while further analysis showed GPs did not feel in control of referring for psychological-based treatment.Conclusion: Using TPB helped to explain GPs’ antidepressant prescribing and referral to psychological-based treatment behaviours. GPs’ intention to prescribe and refer were shown to be moderated by behavioural and normative beliefs, while control beliefs were non-significant. The presence of personal experience as a predictable feature to prescribing and referral behaviour is something that could figure more prominently within early phases of medical training.

Diagnosis and management of transient ischemic attacks in primary care: a systematic review

ABSTRACT INTRODUCTION Many patients who suffer a transient ischaemic attack (TIA) present to their general practitioner (GP). Early identification and treatment reduces the risk of subsequent stroke, disability and mortality. AIM To review the accuracy of TIA diagnosis in primary care, immediate management and interventions to assist GPs with the condition. METHODS This study included the search of Medline, Embase, Web of Science and Scopus databases (1995–2015). Relevant titles and abstracts were obtained using structured criteria (diagnosis, immediate management or intervention of TIAs in primary care), with full review and data extraction for eligible publications. Two reviewers independently assessed quality and extracted information from the 24 eligible studies. The studies had heterogeneous methodology rendering meta-analysis inappropriate, so a narrative synthesis was undertaken. RESULTS Most studies found limitations in GPs’ knowledge and ability to diagnose TIAs to varying extent over time and between countries. GPs tended to over-interpret non-specific symptoms (e.g. isolated vertigo) when considering a TIA diagnosis. Reported referral behaviour varied between countries, with some favouring admission and others preferring outpatient management. Consistent under-referral and under-use of effective medication was reported. However, GPs may refer some patients to exclude rather than confirm a final diagnosis. This, alongside evidence of under-referral, suggests the need for education and decision support tools to enhance referral patterns. Intervention studies suggested that electronic decision support may increase referrals and timely management. CONCLUSION This review revealed deficiencies in knowledge and clinical practice, and identified potential avenues to addressing these. Issues for future research were also identified.

Improving the effectiveness and efficiency of outpatient services: a scoping review of interventions at the primary–secondary care interface

Objectives Variation in patterns of referral from primary care can lead to inappropriate overuse or underuse of specialist resources. Our aim was to review the literature on strategies involving primary care that are designed to improve the effectiveness and efficiency of outpatient services. Methods A scoping review to update a review published in 2006. We conducted a systematic literature search and qualitative evidence synthesis of studies across five intervention domains: transfer of services from hospital to primary care; relocation of hospital services to primary care; joint working between primary care practitioners and specialists; interventions to change the referral behaviour of primary care practitioners and interventions to change patient behaviour. Results The 183 studies published since 2005, taken with the findings of the previous review, suggest that transfer of services from secondary to primary care and strategies aimed at changing referral behaviour of primary care clinicians can be effective in reducing outpatient referrals and in increasing the appropriateness of referrals. Availability of specialist advice to primary care practitioners by email or phone and use of store-and-forward telemedicine also show potential for reducing outpatient referrals and hence reducing costs. There was little evidence of a beneficial effect of relocation of specialists to primary care, or joint primary/secondary care management of patients on outpatient referrals. Across all intervention categories there was little evidence available on cost-effectiveness. Conclusions There are a number of promising interventions which may improve the effectiveness and efficiency of outpatient services, including making it easier for primary care clinicians and specialists to discuss patients by email or phone. There remain substantial gaps in the evidence, particularly on cost-effectiveness, and new interventions should continue to be evaluated as they are implemented more widely. A move for specialists to work in the community is unlikely to be cost-effective without enhancing primary care clinicians’ skills through education or joint consultations with complex patients.