A RESEARCH REPORT SUBMITTED TO THE FACULTY OF HEALTH SCIENCES, UNIVERSITY OF THE WITWATERSRAND, IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH JANUARY 2012 / Background: Nkhensani Hospital is a level 1 district hospital which provides comprehensive and integrated health care for the Giyani sub–district population, which is estimated to be 270 000. The major services provided are casualty, medicine, paediatrics, maternity and surgery. The hospital is experiencing challenges in the maternity ward which is admitting more patients than the 47 allocated beds. Monthly, an average of 400 women are admitted for delivery from clinics. The causes are suspected to be due to a number of different factors like shortage of staff at the clinics, poor referral system, poor services at clinics and health centres, poor facilities, and pregnant woman not attending antenatal care and bypassing lower levels of care. Aim: To describe the pattern and appropriateness of referrals in patients attending the maternity ward at the Nkhensani Hospital. Methodology: A retrospective study was used to review and asses the patient records for the study (January to December 2009). Information was obtained from the Hospital Information System and secondary data from patients records will be used to assess the referral pattern in Nkhensani Hospital’s maternity ward. Results: The data showed that the patients admitted had a mean age of 26 years, with a range from 15 to 45 years. Patients were admitted for various reasons, which when categorised were found to have 57% of inappropriate referrals. Similarly 68% of referrals were found to have low risk pregnancies. About 85% of the deliveries were normal vaginal deliveries. Of the patients who attended the facility, 57% were referred from clinics, 19% from community health centres, 1% from general practitioners and 23% as self referrals. The source of referral was not found to be v associated with appropriate reasons for delivery, risk category, length of stay or mode of delivery. Conclusion: The research showed that the referral pattern in the maternity ward from clinics and health centres as well as self referrals indicated that policies were not being adhered to, which led to an over utilisation of the maternity ward in Nkhensani Hospital under Giyani sub-district

Rapid development in information technology (IT) has substantially affected the hospital world and will continue to be important. This research presents an IT infrastructure and a set of IT capabilities for medical referral in a hospital setting. This includes the introduction of the networking, communication standards, software and hardware, IT capability, and medical referral process as a whole in an electronic environment. The results of this research provide a great knowledge in IT infrastructure and capability for hospitals to implement medical referral. Based on this finding, hospitals can implement electronic medical referral easily.

Abstract Physical therapy (PT) referral model is the major entrance for public to receive professional PT services. In additional to the traditional ¡§restricted referral model¡¨, the new ¡§independent referral model¡¨ is introduced in some regional teaching healthcare institutions. Searching for the appropriate referral model of PT may be the first step for patients to get high quality PT services, and should be concerned and emphasized. The study aims to investigate the perceptions of relevant medical professionals (physicians specialized in orthopedic, neurology, neurosurgery, plastic surgery, family practice, and pediatrics, and physical therapists) and outpatient patients to the current PT referral model in the studied hospitals. Primary findings are as following: 1. Physical therapists are in favor of ¡§independent referral model¡¨ compared to physicians in the surveyed groups. 2. Based on the characteristics of physicians, ¡§field of specialty¡¨ and ¡§confirm with the National Insurance Reimbursement Regulation¡¨ are significant related to their perceptions of the ideal referral model. 3. Based on the characteristics of physical therapists, ¡§age¡¨, ¡§professional education¡¨, and ¡§clinical experience¡¨ are significant related to their perceptions of the ideal referral model. 4. Outpatients in the studied hospitals perceive that physical therapists are more aware of the treated conditions than physicians. 5. Outpatients in the studied hospitals perceive that physical therapists are in a better position for developing rehabilitative plan than physicians.

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

Thesis (D. Min.)--Concordia Seminary, St. Louis, Missouri, 1993. / Includes copy of Community service directory: the most comprehensive human resource referral guide available in the St. Louis/Bi-state area. Includes bibliographical references (leaves 152-154).

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.

As the incidence of major depressive disorders continues to rise, the need for depression screening in primary care is imperative. The objective of this quality improvement (QI) project is to increase depression screening and enhance the current referral process in an urban primary care setting in the southeast United States. To achieve a projected increase in identified depression within the current and future adult patient population, workflow processes have been restructured to incorporate consistent depression screening using the Patient Health Questionnaire-2 (PHQ-2) and -9 (PHQ-9). Revised clerical workflow processes include initiating PHQ-9 questionnaires for all new patients, while clinical workflow processes include conducting PHQ-2 questionnaires for all established patients. Scores on the PHQ-9 indicating moderate levels of depression will trigger primary care provider (PCP) notification. Providers offer three treatment options including Behavioral Health Care Navigator Services (BHCN), self-referral to a mental health care provider, or treatment by PCP. Data will be collected to determine the number of PHQ-9 questionnaires given to “New Patients” at check-in, PHQ-2 questionnaires conducted by clinical staff, PHQ-9 scores of 10 or greater, BHCN referrals placed, patients who elected self-referral, and completed initial mental health appointments with differentiation between BHCN scheduled appointments and self-referred appointments. This QI project is currently undergoing implementation with no outcomes to report, however, data collected during analysis is expected to reveal an increase in patients diagnosed with moderate to major depressive disorders and an increase in completed initial mental health appointments.

As the prevalence of autism spectrum disorder (ASD) rises, the demand for services also increases. For individuals on the autism spectrum to access most of these services, a formal diagnosis is necessary. An accurate diagnosis also informs the type of services a child receives and whether that treatment will appropriately address their symptoms. Unfortunately, there is a shortage of professionals trained to recognize the signs of ASD and perform ASD diagnostic assessments. Thus, waitlists for diagnostic assessments can be months to years long. The problem of too few trained professionals is compounded by inappropriate referrals (i.e., children referred for ASD evaluations who do not exhibit signs of ASD). When children are referred to an inappropriate service, waitlists can be unnecessarily lengthened. Long waitlists can delay access to services with limited availability for children who would benefit from them by creating a bottleneck effect. Additionally, it may delay access to services for the incorrectly referred child who waits for inappropriate services (e.g., behavior therapy for ASD) rather than being directed to more appropriate services with potentially shorter waiting times (e.g., Cognitive-Behavioral Therapy for social anxiety). Children are typically referred for ASD-specific diagnostic assessments after failing a screening measure. However, existing screening measures have high rates of false positives. Further, given the misconceptions surrounding ASD, children may be referred based on symptoms that are incorrectly assumed to be symptoms of ASD (e.g., inattention, hyperactivity). Many children receive another diagnosis before being diagnosed with ASD, while other families are told their child does not have ASD before ultimately receiving an ASD diagnosis, suggesting that many referral sources and diagnosticians (e.g., pediatricians) lack proper knowledge of the symptom patterns seen in children on the autism spectrum. Adults who have frequent contact with children (e.g., teachers, parents) are ideally situated to identify signs of ASD as they see children over long periods of time and in a variety of situations. However, research shows that these individuals may lack knowledge and have misconceptions about ASD and the corresponding patterns of behavior and symptoms. Thus, for them to serve as effective early identifiers and accurate referral sources, they will need training in the presentation and diagnostic criteria of ASD. The present study examined whether a brief and specific training increased parents’ and teachers’ knowledge of ASD and their ability to accurately identify children in need of referrals for ASD diagnostic services. Sixty-four parents of children ages 4 to 12 years and 24 teachers and teachers’ aides (referred to collectively as teachers) of pre-k through 5th grade were recruited through social media. Participants were primarily women (81.3% of parents, 83.3% of teachers) and White (81.3% of parents, 75.0% of teachers). All participants completed a demographics questionnaire and baseline measures of ASD knowledge and referral accuracy (assessed using hypothetical case examples). Participants were randomly assigned to view either a 5-minute video about ASD or a short brochure. Both training materials included the same information and wording. After the brief training intervention, post-training ASD knowledge and referral accuracy were assessed. Parents and teachers did not significantly differ in their baseline ASD knowledge nor their baseline referral accuracy. Additionally, there was not a significant increase in ASD knowledge from baseline to post-training for the sample. ASD knowledge was correlated with referral accuracy at baseline and post-training. The gender of the hypothetical case examples did not influence participants’ referral decisions. The majority of the sample had adequate baseline knowledge of ASD. Additionally, referral accuracy was also high at baseline. Therefore, it is possible that the training materials reviewed by the participants did not present information that was new to them. It is unclear if the degree of knowledge and referral accuracy in the present sample is reflective of the general population without replication. Future studies should examine ASD knowledge and referral accuracy in larger and more diverse samples. Additionally, the effect of the training in a sample with inadequate knowledge should also be studied.

No / In Autumn 2010, a multidisciplinary group of clinicians met in Manchester to discuss the issue of debridement in wound management. There are various debridement techniques available in the UK, but facilities and skills vary. This paper, resulting from the meeting, briefly outlines the differing techniques used, the levels of skill required to use them and the wound types for which they are appropriate. It is important that clinicians practising debridement are aware of the variations in method, and the limitations of their own skills and competency so that, if appropriate, the patient can be referred to receive timely and appropriate intervention.

No description available.