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

The ability of a patient to access physiotherapy directly (patient self-referral), although used widely in the private sector, is not the mechanism in use within the NHS where there exists a system of open access controlled by doctors. This study aimed to develop, implement and investigate a direct access physiotherapy service within a primary care setting in a health district of Scotland. The service was introduced and compared to the existing system of open access over a twelve-month period (1997-1998). Demographic and clinical data was collected relating to two samples: Control Year Group: All GP referrals for a year prior to the study year collected retrospectively. Study Year Group: General practitioner (GP) and direct access (DA) referrals. All patients were followed up one-month after discharge, and the number of associated GP consultations collated together with patient, physiotherapist, general practitioner and service non-user views of physiotherapy generally and direct access specifically. There were similar numbers of referrals (339 vs. 340) with no significant differences with regard to patient age or gender between the Control and Study Year Groups. The Study Year Group however revealed significant differences between DA and GP referrals. DA referrals, all of which were appropriate, accounted for 22.4% of total referrals in comparison to 77.6% GP referrals. DA patients were more likely to have been: male, younger, suffering from conditions of a shorter duration, in paid employment with less work absence, who were more compliant with attendance, had fewer physiotherapy contacts, lower reporting of symptom severity at discharge and were more highly satisfied with their physiotherapy care. This group also demonstrated a greater confidence in knowing when to access physiotherapy and were highly supportive of the effectiveness of physiotherapy. DA patients also consulted their general practitioner significantly less often than GP referrals (p = 0.001). Support for direct access was strongly expressed by service users and nonusers, physiotherapists and general practitioners. Direct access to physiotherapy is an example of an innovative, flexible approach to primary care service provision encouraged by current health policy.

Thesis (Ph.D.)--Walden University, 2006. / Adviser: Rachel Piferi. 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)

This study looked at physicians' perceptions of the existing process of referral and collaboration between themselves and psychologists. Specifically, this study sought to identify the barriers to referral and collaboration in an effort to improve referral and collaboration between these two fields. A total of nine family physicians were interviewed. Overall, the barriers that were identified by physicians included a lack of feedback provided by psychologists, a low level of collaboration with psychologists, physicians' perception of the financial inaccessibility of psychological care, the lack of information that physicians have on psychologists, and physicians not knowing the resources that were available. Addressing these barriers appears to involve some combination of improving psychologists' feedback and collaboration with physicians, providing physicians with information and education on psychologists and their services, and improving the financial accessibility for patients to receive psychological services. / xiii, 156 leaves ; 28 cm.

Research report (MMed) -- Interdisciplinary Health Sciences, Stellenbosch, 2010. / ENGLISH ABSTRACT: Background The referral system is an important component of the health care system. In public health facilities, a high number of patients’ attendance has lead to a huge burden on the secondary and tertiary level of the care system in terms of manpower, equipments and resources. Public health in South Africa consumes around 11% of the government's total budget. The state contributes about 40% of all expenditure on health; the public health sector is under pressure to deliver services to about 80% of the population. Despite the huge spending on health care in most developing countries, health outcomes and services remain poor. Few studies are available to give insights into reasons for this disparity. Therefore the findings of this may help to explain some of the reasons for this overburden of public health facilities and further to make recommendations on how health service delivery may be improve on. The results of this study can be useful in future planning; this may lead to a reduction in huge health expenditure incurred by most developing countries. Methods A cross sectional survey of three different groups of people which comprises of 273 patients, 28 referral centre participants and 19 referring centre participants was carried out. All patients referred from Motherwell community health centre to Dora Nginza hospital were eligible for the study. Questionnaires were interview administered to patients after they had finished consultations in Dora Nginza Hospital. Health professionals from both facilities were also interviewed with the use of self administered questionnaires. Results Three out of every four patients interviewed were of the opinion that their referral to hospital was appropriate which is consistent with the results from referring health professionals, eighteen of nineteen respondents. However, only one-quarter (7) of the referral centre health professionals felt the referrals from referring centre to hospital were appropriate p<0.01.The majority of the patients were satisfied with the level of service received at the referral centre. 77% (210) reported that the staff at the referral centre was friendly and 84% (230) were happy with the explanation given for their illness. However, a source of concern is that, in most of the referred patients 58% (215), there was no formal response back to their primary care. In the referring centre, participants identified transportation of patients to referral centre as the major problem encountered when referring patients 68 % (13), whereas 32 % (6) felt it is communication. In addition, 73 % (14) were of the opinion that transportation was inadequate and 89 % (17) reported the response rate of transport was unsatisfactory. In the referral centre, results showed participants were more concerned about the adequacy of information provided in the referral letters with 78% (22) reporting they were often not adequate information on the referral letters. However, half of the respondents agreed that they do not have clear referral guidelines. Conclusion Primary care health professionals and patients in this study view the referrals to higher levels of care as appropriate. However, the referral centres health professionals were of the opinion that most referrals were inappropriate. The opinion of the referral centre can be attributed to their negative attitudes towards referrals. The referral centres needs to provide more support to primary care for a more efficient referral system .They also need to improve on the continuity of care by providing feedback to referrals. On the other hand, the primary health care needs to be strengthened in terms of resource allocation in order to gain more confidence from both patients and referral centres. / AFRIKAANSE OPSOMMING: geen opsomming

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.

INTRODUCTION AND BACKGROUND: Traditionally, patient referral occurs from a primary healthcare facility to a secondary or tertiary healthcare facility. Despite these formalised procedures in place, it has been reported within the global context that patients often circumvent these procedures and apply various forms of selfreferral to tertiary hospitals. Through self –referral to the high level of care, patients’ diagnoses and care are interrupted and get lost along the way. AIM/ OBJECTIVES: The overall aim of this study was to develop strategies for patients’ self-referral in tertiary hospitals in Gauteng. In order to achieve this aim, the specific objectives of the study were: Phase 1 Objective 1: To explore and describe current patients’ self-referral patterns from patients and healthcare professionals’ perspectives in tertiary hospitals in Gauteng Province. Phase 2 Objective 2: To develop strategies for managing patients’ self-referral in tertiary hospitals in Gauteng Province. METHODOLOGY: A qualitative research approach using critical ethnography was used. Purposive or judgment sampling was used as the researcher considers the participants to have a profound knowledge and in-depth information on the phenomenon. Data was generated through three phases: in-depth interviews with patients and healthcare professionals (registered nurses and doctors) rendering services to self-referred patients in Gauteng Chronic clinics based in tertiary hospitals; reviewing of relevant site documents; and imbizo as policy discussion forum between the service providers and users of the services were held for the development of patient self-referral strategies. Data was analysed through the analytic five steps framework as advocated by the nurse ethnographers Roper and Shapira (2000: 98). FINDINGS: From the analysis of data five themes emerged as the pathways.. These pathways are emergency admissions, word of mouth, admissions in disguise, enabling patients to pay for admission, human rights, and sense of belonging. CONCLUSION: This study provided a baseline data on self –referral of chronic disease patients in tertiary hospitals in Gauteng Province. Given the epidemiology of chronic disease in South Africa, there is a need for innovative ways of bending the costs for treatment of such. The implementation of National Health Insurance (NHI) will address this problem as NHI has to have a self –referral scheme. The use of the hybrid (new technology and traditional) strategies will facilitate access to care and empowerment of patients to initiate self –referral. / Thesis (PhD)--University of Pretoria, 2019. / Nursing Science / PhD / Unrestricted

Time-series analysis designs strengthen before and after studies and are regarded as easy and cheap to use. These designs have recently become more popular in guideline implementation studies but there is suspicion that time series analysis designs are used inappropriately or without sufficient understanding or the underlying methodology. In this thesis, we attempt to evaluate their use by means of a systematic review of published studies, and by actively using time series analysis to evaluate the effect of dissemination of the 3rd edition of the Royal College of Radiologists' guidelines on imaging referral patterns from primary care in the North East of Scotland. The systematic review established that indeed many time series studies are conducted inappropriately with key issues such as the use of adequate number of data points and adjustment for trends not taken into consideration. Often results are tested using non-statistical analyses. Our findings suggest that there should be an increased awareness among investigators of the correct statistical technique for performing and analysing time series analyses. From the guideline evaluation study, it was found that the passive dissemination of the imaging guideline in the North East of Scotland did not affect GPs' imaging referral patterns. This may suggest the need for reinforcement with more active dissemination strategies. It was also established that time series analysis can be complex, requiring a clear understanding before use if researchers are to achieve the best from them. Compared to time series analysis before and after studies were shown to be unreliable with the potential of giving misleading results.

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.