Background:  Outpatient clinics are struggling to deal with increasing workload and demand for services and hence to meet performance indicators and waiting time targets.  Outpatient services are trying to achieve effective and efficient health care in overcrowded, busy clinic settings.  Open access clinics have been advocated as a way of improving outpatient services. Methods:  A cluster randomised trial was undertaken of a guideline based open access urological investigation service for two common conditions - prostatism and microscopic haematuria.  The trial used a balanced incomplete block design.  The study involved sixty-six (73%) of general practices in the Grampian region of Scotland.  Data were collected before and after the intervention on general practitioners’ pre-referral and post-referral management, hospital management, patient outcome and costs.  Analysis was by intention-to-treat and multilevel modelling was adopted for analyses conducted at the individual patient level. Findings:  General practitioners’ compliance with referral guidelines increased (difference in means 0.5; 95% confidence interval 0.21 to 0.81, P>0.001).  Approximately 50% of patients were referred though the new system.  There were no changes in the number or casemix of referrals.  The intervention reduced waiting time from referral to initial outpatient appointment (ration of means 0.7; 0.55 to 0.89, prostatism patients only) and increased the number of patients who had a management decision reached at initial appointment (odds ratio 5.8; 2.9 to 11.5, P<0.00001, both conditions).  Patients were more likely to be discharged within 12 months (odds ratio 1.7; 0.9 to 3.8, P=0.11).  Overall the new service was probably cost saving to the NHS. Interpretation:  The guideline based open access investigation service streamlined the process of outpatient referral and resulted in a more efficient service with reduced outpatient waiting times.

Thesis (M.H.S.A.)--University of Michigan, 1982.

Thesis (M.H.S.A.)--University of Michigan, 1982.

by Chong Yu Hoi. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 166-172). / Chapter 1. --- Introduction --- p.1 / Chapter 2. --- Background --- p.5 / Chapter 2.1. --- Evolution of Primary Health Care in Last TwoDecades 226}0ؤ An Overview --- p.5 / Chapter 2.2. --- Role of Primary Health Care --- p.11 / Chapter 2.3. --- Significance of Referral Between Primary and Secondary Health Care --- p.12 / Chapter 2.4. --- Attributes of Referral --- p.14 / Chapter 2.4.1. --- Referral Rate --- p.14 / Chapter 2.4.2. --- Referral Pattern --- p.19 / Chapter 2.4.3. --- Reason of Referral --- p.20 / Chapter 2.4.4. --- Appropriateness of Referral --- p.24 / Chapter 2.4.5. --- Referral Letter --- p.30 / Chapter 3. --- Situation in Hong Kong --- p.34 / Chapter 3.1. --- Health of the Society --- p.34 / Chapter 3.2. --- History of GOPC Service in Hong Kong --- p.35 / Chapter 3.3. --- Present Situation of GOPC Services --- p.37 / Chapter 3.4. --- Previous Surveys on Private Practice in Hong Kong --- p.38 / Chapter 3.5. --- Previous Surveys on GOPC Services in Hong Kong --- p.39 / Chapter 3.6. --- A Review of Data from 12 GOPCs --- p.44 / Chapter 4. --- The Study: Objectives and Method --- p.48 / Chapter 4.1. --- Objectives --- p.48 / Chapter 4.2. --- Materials & Method - The Framework of the Study --- p.51 / Chapter 4.3. --- Phase One --- p.52 / Chapter 4.3.1. --- Study Population --- p.53 / Chapter 4.3.2. --- Sampling Method --- p.53 / Chapter 4.3.3. --- Survey Method --- p.53 / Chapter 4.3.4. --- Data Analysis --- p.54 / Chapter 4.4. --- Phase Two --- p.55 / Chapter 4.4.1. --- Study population --- p.56 / Chapter 4.4.2. --- Sampling Method --- p.57 / Chapter 4.4.3. --- Survey Method --- p.57 / Chapter 4.4.4. --- Data Analysis --- p.58 / Chapter 4.5. --- Phase Three --- p.59 / Chapter 4.5.1. --- Study Population --- p.59 / Chapter 4.5.2. --- Sampling Method --- p.60 / Chapter 4.5.3. --- Survey Method --- p.60 / Chapter 4.5.4. --- Data Analysis --- p.60 / Chapter 5. --- Study Result: Phase One --- p.62 / Chapter 5.1. --- The Response Rate --- p.62 / Chapter 5.2. --- Profile of Patients --- p.63 / Chapter 5.3. --- Referral Rate --- p.64 / Chapter 5.3.1. --- The Spectrum In Hong Kong --- p.64 / Chapter 5.3.2. --- Relationship with Individual GOPC --- p.65 / Chapter 5.3.3. --- Relationship with Practice Size --- p.66 / Chapter 5.3.4. --- Relationship with the Day of the Week --- p.67 / Chapter 5.3.5. --- Relationship with Workload of the Day --- p.69 / Chapter 5.3.6. --- Relationship with Workload of Doctor --- p.70 / Chapter 5.3.7. --- Relationship with Basic Medical Training --- p.72 / Chapter 5.3.8. --- Relationship with Year of Experience --- p.73 / Chapter 5.3.9. --- Relationship with Higher Qualification --- p.73 / Chapter 5.4. --- Referral Pattern --- p.74 / Chapter 5.5. --- Reason of Referral --- p.75 / Chapter 5.6. --- Prescription Rate --- p.77 / Chapter 5.7. --- Investigation Rate --- p.78 / Chapter 5.8. --- Duration of Disease before Referral --- p.78 / Chapter 5.9. --- Number of GOPC consultation before Referral --- p.79 / Chapter 6. --- Study Result: Phase Two --- p.82 / Chapter 6.1. --- Response Rate --- p.82 / Chapter 6.2. --- Background of the Referral --- p.83 / Chapter 6.2.1. --- GOPCs of Referral --- p.83 / Chapter 6.2.2. --- Waiting Time for SOPC Appointment --- p.85 / Chapter 6.2.3. --- The patients --- p.86 / Chapter 6.3. --- Present Complaint --- p.87 / Chapter 6.3.1. --- Duration of Disease before Referral --- p.87 / Chapter 6.3.2. --- Number of GOPC Consultation before Referral --- p.89 / Chapter 6.4. --- Assessment of Referral --- p.90 / Chapter 6.4.1. --- Management of Referring Doctor --- p.90 / Chapter 6.5. --- Referrals with Inappropriate Necessity --- p.91 / Chapter 6.5.1. --- The Patients --- p.91 / Chapter 6.5.2. --- Referring GOPCs --- p.93 / Chapter 6.5.3. --- The Specialties --- p.94 / Chapter 6.5.4. --- "Diagnosis, Investigation & Treatment" --- p.95 / Chapter 6.5.5. --- Timing of Referral --- p.97 / Chapter 6.5.6. --- Duration of Present Attack --- p.97 / Chapter 6.5.7. --- Outcome of Referral --- p.97 / Chapter 6.6. --- Referrals with Inappropriate Timing --- p.98 / Chapter 6.6.1. --- The Patients --- p.98 / Chapter 6.6.2. --- The Referring GOPCs --- p.98 / Chapter 6.6.3. --- The Specialties --- p.100 / Chapter 6.6.4. --- Necessity of Referral --- p.101 / Chapter 6.6.5. --- Number of GOPC Visit before Referral --- p.101 / Chapter 6.6.6. --- Number of GOPC Visit with Specialty --- p.102 / Chapter 6.6.7. --- Duration of Disease --- p.103 / Chapter 6.6.8. --- Duration of Disease with Specialty --- p.104 / Chapter 6.6.9. --- "The Diagnosis, Number of GOPC Visit and Duration of Illness" --- p.105 / Chapter 6.6.10. --- Investigation & Treatment Prescribed --- p.107 / Chapter 6.6.11. --- Prognosis of the Referred Cases --- p.109 / Chapter 6.7. --- Referrals with Inappropriate Investigation --- p.110 / Chapter 6.7.1. --- The Patients --- p.110 / Chapter 6.7.2. --- The Referring GOPCs --- p.110 / Chapter 6.7.3. --- The Specialties --- p.112 / Chapter 6.7.4. --- The Diagnosis & Investigation --- p.113 / Chapter 6.7.5. --- Prognosis of Referral --- p.115 / Chapter 6.8. --- Referrals with Inappropriate Treatment --- p.115 / Chapter 6.8.1. --- The Patients --- p.115 / Chapter 6.8.2. --- Referring GOPC --- p.115 / Chapter 6.8.3. --- The Specialties --- p.117 / Chapter 6.8.4. --- The Diagnosis & Treatment --- p.118 / Chapter 6.8.5. --- Prognosis of the Referred Cases --- p.119 / Chapter 6.9. --- Assessment of the Referral Letter --- p.120 / Chapter 7. --- Study Result: Phase Three --- p.122 / Chapter 7.1. --- The Response Rate --- p.122 / Chapter 7.1.1. --- The GOPC Doctors --- p.122 / Chapter 7.1.2. --- The Specialists --- p.123 / Chapter 7.2. --- Profile of GOPC Doctors --- p.123 / Chapter 7.2.1. --- Years of Clinical Practice --- p.123 / Chapter 7.2.2. --- Qualification Obtained --- p.124 / Chapter 7.3. --- Profile of Specialists --- p.125 / Chapter 7.3.1. --- Years of Clinical Practice --- p.125 / Chapter 7.3.2. --- Qualification Obtained --- p.126 / Chapter 7.4. --- Workload of the Participating Doctors --- p.126 / Chapter 7.4.1. --- Number of outpatient Seen by GOPC Doctors --- p.126 / Chapter 7.4.2. --- Number of outpatient Seen by Specialists --- p.126 / Chapter 7.5. --- Referrals from GOPCs to Specialist Clinics --- p.127 / Chapter 7.5.1. --- Percentage of GOPC Cases Referred to Specialist Clinics --- p.127 / Chapter 7.5.2. --- Percentage of Specialist Cases Referred from GOPCs --- p.127 / Chapter 7.6. --- Communication between GOPC and Specialist Clinic --- p.128 / Chapter 7.6.1. --- Opinion of GOPC Doctors on Referral Letters --- p.128 / Chapter 7.6.2. --- Opinion of GOPC Doctors on Feedback from Specialists --- p.130 / Chapter 7.6.3. --- Opinion of Specialist on Referral Letters --- p.131 / Chapter 7.6.4. --- Opinion of Specialists on Their Feedback --- p.135 / Chapter 7.7. --- The Form of Feedback from Specialists --- p.136 / Chapter 7.8. --- Suggestions on Improving the Communication --- p.137 / Chapter 7.9. --- In Service Training for GOPC Doctors --- p.138 / Chapter 8 --- _ Discussion and Recommendation --- p.141 / Chapter 8.1. --- Limitations and Comments --- p.141 / Chapter 8.1.1. --- Representativeness of The Sample --- p.141 / Chapter 8.1.2. --- Response Rate --- p.141 / Chapter 8.1.3. --- Size of The Sample --- p.142 / Chapter 8.1.4. --- Short Duration of the Study --- p.142 / Chapter 8.1.5. --- Discontinuity of Phase One and Phase Two --- p.143 / Chapter 8.2. --- Discussion --- p.144 / Chapter 8.2.1. --- Referral Rate in Hong Kong --- p.145 / Chapter 8.2.2. --- Referral Pattern and Reason of Referral --- p.147 / Chapter 8.2.3. --- Appropriateness of Referrals --- p.149 / Chapter 8.2.4. --- Communication between GOPCs & SOPCs --- p.149 / Chapter 8.2.5. --- In Service Training for GOPC Doctors --- p.150 / Chapter 8.2.6. --- Waiting Time for SOPCs Appointment --- p.151 / Chapter 8.2.7. --- Prescription Rate --- p.152 / Chapter 8.2.8. --- Common Investigations Requested by Specialists --- p.153 / Chapter 8.2.9. --- Factors Associated with Referral Rates --- p.155 / Chapter 8.2.10. --- Factors Associated with Appropriateness of Referrals --- p.157 / Chapter 8.2.11. --- Factors Associated with Timing of Referrals --- p.158 / Chapter 8.3. --- Recommendation --- p.161 / Chapter 8.3.1. --- Further Study in Private Sector --- p.161 / Chapter 8.3.2. --- Further Study in Other Regions --- p.161 / Chapter 8.3.3. --- Further Study on the Appropriateness of those Non-referrals --- p.161 / Chapter 8.3.4. --- Improve Record in Specialist Clinics --- p.162 / Chapter 8.3.5. --- Upgrade of GOPC Drug Formulary --- p.162 / Chapter 8.3.6. --- Standard Referral & Feedback Form --- p.163 / Chapter 8.3.7. --- Shared Care Program between SOPCs & GOPCs --- p.163 / Chapter 8.3.8. --- Medical Record System in GOPCs --- p.163 / Chapter 8.3.9. --- Further Training for GOPC Doctors --- p.164 / Chapter 8.3.10. --- Principal Medical Officer for GOPC Service --- p.164 / Chapter 9. --- Reference --- p.166 / Chapter 10. --- Appendix --- p.173

Thesis (M.H.A.)--University of Michigan, 1966.

Thesis (M.H.A.)--University of Michigan, 1973.

Thesis (M.H.S.A.)--University of Michigan, 1982.

Thesis (M.H.A.)--University of Michigan, 1963.

Thesis (M.H.S.A.)--University of Michigan, 1976.

Thesis (M.H.A.)--University of Michigan, 1963.