Thesis--PlanA (M.S.)--University of Wisconsin--Stout, 2001. / Includes bibliographical references.

The purpose of this research was to develop a model of the complex process of medical referral, in which a physician consults with or refers a patient to a specialist. Fifty cases of referral were investigated by interviewing the referring physician, patient and specialist(s). Involved with the case at various points before and after the referral. Referrals were followed first in a southern Ontario city and, for comparison, in northwestern Ontario. Trust in the competence of specialist advisors was found to be the key component in understanding the process of referral. Referral in settings where there is mutual respect between referring physicians and consultants, particularly where they worked in close physical association, was contrasted with referral in settings where there is isolation of referring doctor from consultant, and a tendency towards breakdown in the process of the referral. Finally, when the activities and beliefs of patients as well as doctors were examined, patients were found to have a much greater influence on the initiation, process and outcome of referral than has been previously recognized. / Thesis / Doctor of Philosophy (PhD)

There is a perception that some of the pregnant women referred from district to regional hospitals should have been managed at the former hospitals. To establish the truth of this perception, a quantitative, exploratory, descriptive and contextual study was undertaken to determine to what extent pregnant women admitted to a regional hospital are appropriately referred from district hospitals according to criteria described in the Guidelines for Maternity Care in South Africa and in the Primary Health Care Package for South Africa. Maternity case records of two hundred and eighty pregnant women admitted to a regional hospital in the Eastern Cape Province following referral from district hospitals between 1 July 2005 and 31 December 2005 were reviewed and analysed. The majority of these women were referred for medical complications, previous caesarean section, failure to progress in labour, obstructed labour, preterm baby and eclampsia. The commonest reasons cited for the transfer of these patients were shortage of maternity care providers in maternity units and lack of expertise at district hospital level. A lack of drugs and equipment were less commonly cited as the reason. Criteria for referral from district to regional hospitals were fulfilled in only 78 (34.2%) of the referrals. This low level of fulfillment of the criteria is attributed to the apparent lack of feedback processes between district and regional hospitals. This in turn limits the opportunity to develop competencies and skills of staff at these maternity units. To address this issue a referral strategy for implementation in the Eastern Cape Province was developed and presented in this study.

MMed (Paediatrics), Faculty of Health Sciences, University of the Witwatersrand / The aim of regionalisation of neonatal services is to offer a basic level of care to the majority of the obstetric/neonatal population who are at low risk, with smaller numbers of more specialised hospitals offering higher levels of care to the fewer, higher-risk patients. On review of relevant literature there has long been a shortage of neonatal intensive care unit (NICU) beds in the South African public sector. This study was an audit within a referral system in the public sector. The aim was to identify the need for NICU beds, establish whether the need was being met, ascertain which patients required referral and which were accepted, and delineate factors that influenced the outcome of acceptance versus refusal. Subjects and Methods Data collection took place between 30 October and 11 December 2006. Seven health facilities in southern Gauteng were included as study sites. These included 2 primary healthcare clinics, 3 district, 1 regional hospital and the tertiary referral facility, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The study included all neonates requiring transfer to a NICU, for any reason, during the study period. Data collection relied upon completion of information sheets by doctors requesting or accepting transfer of ill neonates at each of the hospitals involved. The primary outcome was acceptance or refusal at CMJAH NICU. Secondary outcome was survival or death within the study period. Results Forty-seven external requests for NICU beds were recorded at CMJAH and another 22 requests came for births within CMJAH. Only 13 (28%) of external requests were accepted. All internal requests were accommodated. Most requests came from level 2 (district or regional) hospitals, many outside the designated referral system, mainly for infants with respiratory distress. Infants older than 24 hours of age (OR 0.16; 95% CI 0.04-0.65), those with congenital abnormalities, and those requiring surgery (OR 0.11; CI 0.23-0.57) were significantly more likely to be accepted. Greater numbers of staff on duty at CMJAH also correlated with the probability of acceptance into NICU. Conclusion Relatively few external requests were accepted. CMJAH provides sub-specialist services including paediatric surgery and therefore should accept patients requiring such management. However, there was a high number of patients refused admission for ‘simple’ neonatal respiratory conditions. Level 2 hospitals should be able to manage these. Furthermore, hospitals are not following strict referral protocols. The findings are indicative of the continued shortage of neonatal intensive care beds, poor adherence to referral guidelines, and a general failure of regionalisation within the sector under consideration.

Thesis (M.Tech. (Chiropractic))--University of Johannesburg, 2007. / Also available via World Wide Web.

M.Tech. / “It is through cooperation, rather than conflict, that your greatest successes will be derived” (www.inspiring-quotes-and-stories.com, 26 March 2007). This proclamation can be aptly applied to the notion that an integrated healthcare team that is open to an interdisciplinary approach to a patient’s healthcare needs, will have the patient’s best interests at heart and most likely a holistic solution as opposed to treating the patient with individual approaches. The aim of this study was to establish the inter-referral patterns between Chiropractors and Physiotherapists in the Western and Northern regions of Johannesburg, as there had been no research conducted in this regard. In this way an assessment of interdisciplinary communication and referral could be established between the two professions and steps could then be initiated to improve this if found necessary. A questionnaire was sent to Chiropractors and Physiotherapists in this region. These questionnaires were tailored to the professional discipline of the subject. It asked a range of questions relating to their background, knowledge of the other profession being surveyed and their opinion on the credibility of the other profession’s ability to treat certain conditions. The results were then tabulated and statistically calculated and verified to establish the end results. The results of this study found that Chiropractors were more open to referrals to Physiotherapists regarding only certain conditions, whilst Physiotherapists were less inclined to refer to Chiropractors in general.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Thesis (M. Med. Sc.)--University of Hong Kong, 2005. / Also available in print.

Thesis (M.H.A.)--University of Michigan, 1959.

Thesis (M.H.A.)--University of Michigan, 1959.