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Laschke ADL, Blaakær J, Jensen CF, Larsen MB. Differences in the referral process from general practice to resident specialists in gynaecology depending on density of specialists and patients' socioeconomic status. Scand J Prim Health Care 2023:1-10. [PMID: 37837435 DOI: 10.1080/02813432.2023.2268663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 10/04/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND There are significant differences in the densities of resident specialists in gynaecology (RSGs) in various regions of Denmark. It is unclear whether this disparity affects gynaecological patients' experience of the referral process and whether it differs in terms of their socioeconomic status (SES). OBJECTIVE To examine gynaecological patients' experiences of the referral process to an RSG concerning RSG density and patients' SES. DESIGN Cross-sectional questionnaire and registry-based study. SETTING In Denmark, general practitioners (GPs) serve as gatekeepers of secondary care and are responsible for referrals to resident specialists as well as inpatient and outpatient hospital care. SUBJECTS A total of 2917 patients who consulted an RSG participated in this study. MAIN OUTCOME MEASUREMENTS Patients' experiences of referral to an RSG, waiting times, involvement, and how they experienced the referral process. RESULTS Patients who lived in the highest density RSG region were referred to an RSG more promptly after the onset of symptoms, had to visit their GP less frequently to obtain a referral to the RSG, and rarely received a gynaecological examination by their GP compared with those living in regions with lower RSG densities. Moreover, their waiting times were shorter, and more often, the patients themselves proposed to be referred to an RSG. The findings show that RSG density had a greater impact on women's experiences than SES. CONCLUSION To allow equal access to specialist care, RSG density must be equal across all regions in the country.
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Affiliation(s)
- Alexander D L Laschke
- Speciallægeselskabet Alexander Laschke ApS, Aabenraa, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan Blaakær
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense C, Denmark
| | | | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, University Research Clinic for Cancer Screening, Randers, Denmark
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Yu D, Moody J, Singer AG, Sareen J, Hensel J. Psychiatric consultation: Characteristics, satisfaction, and perceived opportunities among referrers to a 1-time service. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:481-489. [PMID: 37451985 PMCID: PMC10348790 DOI: 10.46747/cfp.6907481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To further understand and optimize primary care provider (PCP) referrals to a 1-time psychiatric consultation service by developing profiles of PCP referrers, assessing PCP satisfaction with the service, and determining intervention opportunities. DESIGN Secondary analysis of a referral database and subsequent cross-sectional survey of referrers. SETTING Winnipeg, Man. PARTICIPANTS All family physicians who had made at least 1 referral in 2017 to the Centralized Psychiatric Consultation Service for Adults, a 1-time consultation service. MAIN OUTCOME MEASURES Referral frequency, individual and practice characteristics, satisfaction with the Centralized Psychiatric Consultation Service for Adults, and subjective drivers of referral activity were assessed. Interest in a range of intervention opportunities to increase mental health knowledge and support were also examined. RESULTS Of the 403 family physicians who referred patients to the consultation service in 2017, a total of 111 (27.5%) responded to the survey. Among all referrers, 287 (71.2%) were low referrers (1 to 4 referrals), 65 (16.1%) were moderate referrers (5 to 9 referrals), and 51 (12.7%) were high referrers (≥10 referrals). Solo practice (P=.04) and no access to collaborative mental health services (P<.001) were significantly associated with being a high referrer. Roughly 26.3% of low referrers, 29.2% of moderate referrers, and 15.4% of high referrers were satisfied with wait times for the service. Higher referrers did not identify a lack of comfort with providing psychiatric care as a driver of referrals; more indicated that they had a high volume of patients with mental health needs, that there was a lack of access to alternative services, and that patients sometimes requested referral. Overall, more than 40% of respondents expressed interest in a mental health care navigator, hard-copy resource information, and rapid access to consultation advice via telephone or an electronic platform. There was less interest in other proposed interventions. CONCLUSION We found referrers to the Centralized Psychiatric Consultation Service for Adults to be clustered based on specific practice characteristics, as well as provider-patient factors. Overall, satisfaction with the service was fair and PCPs were not highly interested in a variety of proposed interventions. Future studies should explore how useful 1-time consultation services are for solo-practising PCPs and how best to support these and other PCPs in their management of patients with mental health needs.
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Affiliation(s)
- Dorothy Yu
- Psychiatry resident in the Department of Psychiatry at the University of Manitoba in Winnipeg.
| | - Jane Moody
- Medical Director of the Central Psychiatric Consultation Service and RACE at the Winnipeg Regional Health Authority and Assistant Professor in the Department of Psychiatry at the University of Manitoba
| | - Alexander G Singer
- Director of Research and Quality Improvement in the Department of Family Medicine at the University of Manitoba
| | - Jitender Sareen
- Head of the Department of Psychiatry at the University of Manitoba and Medical Director and Head of the Winnipeg Regional Health Authority Mental Health Program
| | - Jennifer Hensel
- Medical Director for Adult Telemental Health in the Department of Psychiatry at the University of Manitoba
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Aboelkhir HAB, Elomri A, ElMekkawy TY, Kerbache L, Elakkad MS, Al-Ansari A, Aboumarzouk OM, El Omri A. A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16952. [PMID: 36554837 PMCID: PMC9778793 DOI: 10.3390/ijerph192416952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The referral process is an important research focus because of the potential consequences of delays, especially for patients with serious medical conditions that need immediate care, such as those with metastatic cancer. Thus, a systematic literature review of recent and influential manuscripts is critical to understanding the current methods and future directions in order to improve the referral process. METHODS A hybrid bibliometric-structured review was conducted using both quantitative and qualitative methodologies. Searches were conducted of three databases, Web of Science, Scopus, and PubMed, in addition to the references from the eligible papers. The papers were considered to be eligible if they were relevant English articles or reviews that were published from January 2010 to June 2021. The searches were conducted using three groups of keywords, and bibliometric analysis was performed, followed by content analysis. RESULTS A total of 163 papers that were published in impactful journals between January 2010 and June 2021 were selected. These papers were then reviewed, analyzed, and categorized as follows: descriptive analysis (n = 77), cause and effect (n = 12), interventions (n = 50), and quality management (n = 24). Six future research directions were identified. CONCLUSIONS Minimal attention was given to the study of the primary referral of blood cancer cases versus those with solid cancer types, which is a gap that future studies should address. More research is needed in order to optimize the referral process, specifically for suspected hematological cancer patients.
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Affiliation(s)
| | - Adel Elomri
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Tarek Y. ElMekkawy
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
| | - Laoucine Kerbache
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Mohamed S. Elakkad
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Abdulla Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- College of Medicine, QU-Health, Qatar University, Doha 2713, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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Li S, Hubner A. The Impact of Web-Based Ratings on Patient Choice of a Primary Care Physician Versus a Specialist: Randomized Controlled Experiment. J Med Internet Res 2019; 21:e11188. [PMID: 31254337 PMCID: PMC6625218 DOI: 10.2196/11188] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/04/2019] [Accepted: 05/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background Physician review websites have empowered prospective patients to acquire information about physicians. However, little is known about how Web-based ratings on different aspects of a physician may affect patients’ selection of physicians differently. Objective The objectives of this study were to examine (1) how patients weigh ratings on a physician’s technical skills and interpersonal skills in their selection of physicians and (2) whether and how people’s choice of a primary care physician versus a specialist is affected differently by Web-based ratings. Methods A 2×2×2×2 between-subjects experiment was conducted. Over 600 participants were recruited through a crowdsourcing website and randomly assigned to view a mockup physician review Web page that contained information on a physician’s basic information and patients’ ratings. After reviewing the Web page, participants were asked to complete a survey on their perceptions of the physician and willingness to seek health care from the physician. Results The results showed that participants were more willing to choose a physician with higher ratings on technical skills than on interpersonal skills compared with a physician with higher ratings on interpersonal skills than on technical skills, t369.96=22.36, P<.001, Cohen d=1.22. In the selection of different types of physicians, patients were more likely to choose a specialist with higher ratings on technical skills than on interpersonal skills, compared with a primary care physician with the same ratings, F1,521=5.34, P=.021. Conclusions The findings suggest that people place more weight on technical skills than interpersonal skills in their selection of a physician based on their ratings on the Web. Specifically, people are more likely to make a compromise on interpersonal skills in their choice of a specialist compared with a primary care physician. This study emphasizes the importance of examining Web-based physician ratings in a more nuanced way in relation to the selection of different types of physicians. Trial Registration ISRCTN Registry ISRCTN91316463; http://www.isrctn.com/ISRCTN91316463
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Affiliation(s)
- Siyue Li
- College of Media and International Culture, Zhejiang University, Hangzhou, China
| | - Austin Hubner
- School of Communication, The Ohio State University, Columbus, OH, United States
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Donley T, King DM, Nyathi N, Okafor A, Mbizo J. Socioeconomic Status, Family Functioning and Delayed Care Among Children With Special Needs. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:366-381. [PMID: 30124396 DOI: 10.1080/19371918.2018.1504703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parents of children with special healthcare needs (CSHCN) face tremendous stress in caring for their children. Families of CSHCN face increased barriers to health services as evidence also reflects the influence of socioeconomic factors on access. This study investigates the impact of socioeconomic factors and family functioning on delayed care. Descriptive, bivariate, and adjusted multivariate logistic regression were performed using sampling weights. findings suggest that family dynamics are more impactful on delayed care than socioeconomic predictors. Promoting family-centered care that incorporates social support for families to reduce barriers is essential for improved quality of life and health outcomes.
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Affiliation(s)
- Tiffany Donley
- a Department of Public Health, University of West Florida , Pensacola , Florida , USA
| | - Dione Moultrie King
- b Department of Social Work, University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Nhlanganiso Nyathi
- c Department of Education and Social Care, Anglia Ruskin University , Peterborough
| | - Anthony Okafor
- a Department of Public Health, University of West Florida , Pensacola , Florida , USA
| | - Justice Mbizo
- a Department of Public Health, University of West Florida , Pensacola , Florida , USA
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Geissler KH, Lubin B, Ericson KMM. The Role of Organizational Affiliations in Physician Patient-Sharing Relationships. Med Care Res Rev 2018; 77:165-175. [PMID: 29676190 DOI: 10.1177/1077558718769403] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Provider consolidation may enable improved care coordination, but raises concerns about lack of competition. Physician patient-sharing relationships play a key role in constructing patient care teams, but it is unknown how organization affiliations affect these. We use the Massachusetts All Payer Claims Database to examine whether patient-sharing relationships are associated with sharing a practice site, medical group, and/or physician contracting network. Physicians were 17 percentage points more likely to have a patient-sharing relationship if they shared a practice site and 4 percentage points more likely if they shared a medical group, as compared with sharing no affiliation. However, there was no detectable increased probability of a patient-sharing relationship within the same physician contracting network. Our finding that physician patient-sharing relationships are concentrated within organizational boundaries at practice site and medical group levels helps illuminate referral incentives and provide insight into the role of organizational affiliations in patient care team construction.
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Binns-Calvey AE, Malhiot A, Kostovich CT, LaVela SL, Stroupe K, Gerber BS, Burkhart L, Weiner SJ, Weaver FM. Validating Domains of Patient Contextual Factors Essential to Preventing Contextual Errors: A Qualitative Study Conducted at Chicago Area Veterans Health Administration Sites. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1287-1293. [PMID: 28353498 DOI: 10.1097/acm.0000000000001659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE "Patient context" indicates patient circumstances and characteristics or states that are essential to address when planning patient care. Specific patient "contextual factors," if overlooked, result in an inappropriate plan of care, a medical error termed a "contextual error." The myriad contextual factors that constitute patient context have been grouped into broad domains to create a taxonomy of challenges to consider when planning care. This study sought to validate a previously identified list of contextual domains. METHOD This qualitative study used directed content analysis. In 2014, 19 Department of Veterans Affairs (VA) providers (84% female) and 49 patients (86% male) from two VA medical centers and four outpatient clinics in the Chicago area participated in semistructured interviews and focus groups. Topics included patient-specific, community, and resource-related factors that affect patients' abilities to manage their care. Transcripts were analyzed with a previously identified list of contextual domains as a framework. RESULTS Analysis of responses revealed that patients and providers identified the same 10 domains previously published, plus 3 additional ones. Based on comments made by patients and providers, the authors created a revised list of 12 domains from themes that emerged. Six pertain to patient circumstances such as access to care and financial situation, and 6 to patient characteristics/states including skills, abilities, and knowledge. CONCLUSIONS Contextual factors in patients' lives may be essential to address for effective care planning. The rubric developed can serve as a "contextual differential" for clinicians to consider when addressing challenges patients face when planning their care.
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Affiliation(s)
- Amy E Binns-Calvey
- A.E. Binns-Calvey is project manager, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois, and research specialist, University of Illinois at Chicago, Chicago, Illinois. A. Malhiot is qualitative project manager, C+R Research, Chicago, Illinois. C.T. Kostovich is research health scientist, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois, and associate professor and director of simulation, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois. S.L. LaVela is research scientist, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois, and research assistant professor, Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. K. Stroupe is research health scientist, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois, and associate professor, Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois. B.S. Gerber is professor of medicine, Division of Academic Internal Medicine and Geriatrics, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois. L. Burkhart is research scientist, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois, and associate professor, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois. S.J. Weiner is deputy director, Center of Innovation for Complex Chronic Healthcare, Jesse Brown VA Medical Center, Chicago, Illinois, and professor of medicine, pediatrics and medical education, College of Medicine, University of Illinois at Chicago, Chicago, Illinois. F.M. Weaver is director, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois, and professor, Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
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Barr PJ, Forcino RC, Mishra M, Blitzer R, Elwyn G. Competing priorities in treatment decision-making: a US national survey of individuals with depression and clinicians who treat depression. BMJ Open 2016; 6:e009585. [PMID: 26747036 PMCID: PMC4716198 DOI: 10.1136/bmjopen-2015-009585] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To identify information priorities for consumers and clinicians making depression treatment decisions and assess shared decision-making (SDM) in routine depression care. DESIGN 20 questions related to common features of depression treatments were provided. Participants were initially asked to select which features were important, and in a second stage they were asked to rank their top 5 'important features' in order of importance. Clinicians were asked to provide rankings according to both consumer and clinician perspectives. Consumers completed CollaboRATE, a measure of SDM. Multiple logistic regression analysis identified consumer characteristics associated with CollaboRATE scores. SETTING Online cross-sectional surveys fielded in September to December 2014. PARTICIPANTS We administered surveys to convenience samples of US adults with depression and clinicians who treat depression. Consumer sampling was targeted to reflect age, gender and educational attainment of adults with depression in the USA. PRIMARY OUTCOME MEASURES Information priority rankings; CollaboRATE, a 3-item consumer-reported measure of SDM. RESULTS 972 consumers and 244 clinicians completed the surveys. The highest ranked question for both consumers and clinicians was 'Will the treatment work?' Clinicians were aware of consumers' priorities, yet did not always prioritise that information themselves, particularly insurance coverage and cost of treatment. Only 18% of consumers reported high levels of SDM. Working with a psychiatrist (OR 1.87; 95% CI 1.07 to 3.26) and female gender (OR 2.04; 95% CI 1.25 to 3.34) were associated with top CollaboRATE scores. CONCLUSIONS While clinicians know what information is important to consumers making depression treatment decisions, they do not always address these concerns. This mismatch, coupled with low SDM, adversely affects the quality of depression care. Development of a decision support intervention based on our findings can improve levels of SDM and provide clinicians and consumers with a tool to address the existing misalignment in information priorities.
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Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Rachel C Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Manish Mishra
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- The Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire, USA
| | - Rachel Blitzer
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
- The Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire, USA
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Joseph-Williams N, Davies F, Wood F, Edwards A. Choosing a Specialist. Med Decis Making 2015; 35:688-90. [DOI: 10.1177/0272989x15583267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 03/26/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Natalie Joseph-Williams
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK (NJW, FD, FW, AE)
| | - Freya Davies
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK (NJW, FD, FW, AE)
| | - Fiona Wood
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK (NJW, FD, FW, AE)
| | - Adrian Edwards
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK (NJW, FD, FW, AE)
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