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Referral Process (referral + process)
Selected AbstractsIssues with recruitment to randomised controlled trials in the drug and alcohol field: a literature review and Australian case studyDRUG AND ALCOHOL REVIEW, Issue 2 2008CLARE L. THOMSON Abstract Issues. The randomised control trial (RCT) is a widely used tool for measuring the effectiveness of health treatments and services. However, subject recruitment is an ongoing challenge for those conducting RCTs and may have a serious impact on the success of the study and the reliability of the outcomes. Approach. In this review we present an examination of the problems and strategies associated with recruitment to RCTs, with particular reference to studies conducted in the drug and alcohol field. A case study of recruitment to an RCT for the treatment of alcohol dependence is presented, supplemented by PubMed, Current Contents and Medline searches to identify relevant publications. Key Findings. The literature suggests that the most common barriers to patient participation involve fears of assignment to placebo treatment, insufficient compensation and poor attendance at initial appointments. Moreover, subject referrals from staff may be a greater problem than reluctance of patients. Referrals are inhibited by complicated entry criteria, time constraints due to busy work schedules or a limited research culture. Implications. Subject recruitment may be promoted by financial reimbursement, close partnerships between research and referral staff; increasing the treatment group ratio in multi-drug trials to minimise randomisation to placebo; addressing negative staff attitudes; and simplifying the referral process. Conclusion. The need for multi-centre sites in Australian drug and alcohol treatment studies is highlighted. [source] Continuing care after cancer treatmentJOURNAL OF ADVANCED NURSING, Issue 2 2003Brian Pateman MA MPhil RN DNT Background. Despite nearly three decades of debate and policy guidance there is evidence that, in the United Kingdom, patient hospital discharge remains problematic. District nurses, who deliver skilled home nursing care, receive referrals from hospitals for continuing nursing care needs. However, district nurses' expectations of appropriate patient referral from hospitals are not always achieved. In an attempt to improve services after hospital discharge, government policy has emphasized partnership between care providers, highlighting the need for smooth transition between care settings. Aim. To explore hospital discharge and referral procedures for patients with cancer, with particular emphasis on referrals made by hospital nurses to district nurses. Method. In-depth interviews were carried out with nurses actively involved in the discharge process as both referrers and recipients of referrals. Twenty nurses from a regional cancer centre and 20 district nurses from three adjacent primary care trusts were interviewed. Interviews were transcribed and analysed thematically, and themes compared between the two care settings. Conclusions. We conclude that competing sets of expectations, not only between hospital and community nursing settings, but amongst district nurses themselves, are a major factor impeding agreement on referral criteria and satisfaction with the referral process. [source] Refugee families in therapy: from referrals to therapeutic conversationsJOURNAL OF FAMILY THERAPY, Issue 2 2001Nora Sveaass Refugee families referred for therapy present a wide array of problems and expectations, not always in accordance with what therapy may offer. Major differences between referring professionals, families and therapists regarding problem definitions and solutions may complicate collaboration. Interventions that may overcome these barriers and move initial interviews into a therapeutic context are described. Three patterns regarding referral process, problem presentation and expectations (here called referral contexts) are outlined: ,the relational', where families ask for psychological and interpersonal assistance, ,the unfocused', where families are referred to therapy without expressing any wish for it, and ,the fixed solution', where families seek support for solutions that are not of a therapeutic nature. The interventions described form part of a negotiation where motives and interest for therapy are explored and agreements regarding further therapy are outlined. [source] Improving service delivery by evaluation of the referral pattern and capacity in a clinical genetics setting,,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 3 2009Emma McCann§ Abstract Quality improvement in specialist services such as clinical genetics is challenging largely due to the complexity of the service and the difficulty in obtaining accurate, reproducible, and measurable data. The objectives were to evaluate the pattern of referrals to the All Wales Medical Genetics Service (AWMGS) North Wales Genetics team based in three separate hospitals, define the capacity of the team and implement change to improve equity, timeliness and efficiency of care delivery to patients. The methodology required collating the monthly referral rates retrospectively for each center over a 2.5-year period and plotting on statistical process control charts. Process mapping of the referral process in each center was undertaken, differences documented and a common pathway implemented. "Did not attend" and "time to first appointment" rates were also measured in one center. PDSA methodology was used to implement "patient focused booking." The results show that the range for referral rates in any given month for each center was 3,33 referrals. The range for referral rate for the whole team was 18,64 per month. Since January 2004 the average number of monthly referrals to the North Wales service has increased by 50%. The potential range in monthly referrals varies between centers and the range of the variability has also increased also in two out of the three centers. Introduction of Patient Focused Booking reduced the "Failed to Attend" rate and 100% of patients were offered a choice of appointments. In addition 100% had a first face-to-face contact within 6 weeks if they chose. The measurement of improvement involved firstly introducing a series of continuous measures to provide a baseline for the process prior to the implementation of any changes and secondly to indicate the impact of the changes following implementation. The measures implemented included process (referrals numbers, percentage of patients offered a choice of appointments), outcome (percentage of patients seen within 6 weeks and the percentage failing to attend), and balancing measures (percentage declining the service or failing to respond). It was concluded that general tools of quality improvement can be used to good effect within specialist services. Good processes and accurate, reproducible and measurable data are essential. Small changes can have a major impact both on the quality of the service offered and the ability to deliver the service. © 2009 Wiley-Liss, Inc. [source] Implementation of school-based wellness centersPSYCHOLOGY IN THE SCHOOLS, Issue 5 2003Nancy G. Guerra This article describes the planning, implementation, and evaluation of school-based Wellness Centers operated by the Riverside Unified School District in Riverside, CA, as part of the Safe Schools/Healthy Students Initiative funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). We describe the program as planned in terms of the theoretical model for the intervention and the evaluation design, and discuss the actual implementation including accomplishments and challenges. The program was designed to promote positive development and wellness for individual students via self- and teacher-referrals for personal and mental health problems handled through a case management and referral process, support groups, and other activities such as after-school programs, mentoring, tutoring, and parent training. An effort was also made to promote wellness at the school level by providing wellness campaigns, information, and compatible policies and procedures designed to enhance healthy development. Our observations are based on a qualitative assessment that was a component of the evaluation. A more detailed evaluation examining the impact of school-wide and student-focused activities on academic and behavioral outcomes is currently underway. However, we do include comments from students suggesting that the Wellness Center concept holds much promise for school-based mental health and violence prevention services. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 473,487, 2003. [source] Assessing efforts to mitigate the impacts of drainage on wetlands in Ontario, CanadaTHE CANADIAN GEOGRAPHER/LE GEOGRAPHE CANADIEN, Issue 2 2005Dan Walters The protection of wetlands through the Ontario Drainage Act has been the subject of much debate. While seen as essential for increasing production and/or productivity of agricultural areas, drainage schemes have been usually approved at the expense of wetlands. Despite the presence of a referral process in Ontario's Drainage Act that is supposed to prevent the significant loss of wetland area, incremental losses continue to occur. The referral process allows landowners, drainage engineers, Drainage Superintendents, local conservation authorities and Ontario Ministry of Natural Resource officials to participate in the decision-making process. This research examines the recommended mitigation measures and wetland gains/losses in Zorra Township between 1978 and 1997. Data sources included drainage files, wetland evaluation files, aerial photography and interviews with government officials. The results indicate that while recommended mitigation measures of drainage schemes in the vicinity of wetlands have increased, incremental losses continue to occur. The negotiated settlements among drainage engineers and the referral agencies appear to be inadequate to maintain the spatial extent of wetlands. The regulatory approach fails to motivate changes in land-use management practices. This supports the need to include nonregulatory incentives in the effort to protect wetlands. La protection de wetlands par l'Acte de Drainage de Ontario a été le sujet de beaucoup de débat. Pendant que vu comme essentiel pour augmenter la productivité de et/ou de production de secteurs agricoles, les arrangements de drainage ont été d'habitude approuvés à la dépense de wetlands. Malgré la présence d'un procédé de référence dans l'Acte de Drainage de Ontario'le procédé de référence de s qui est supposé empêcher la perte significative de secteur de wetland, les pertes cumulatives continuent à arriver. Le procédé de référence permet inclut landowners, les ingénieurs de drainage, les Directeurs de Drainage, les autorités de conservation locales, et le Ministère de Ontario d'officiers de Ressource Naturels pour participer dans le procédé de prise de décision. Cette recherche examine les mesures de réduction recommandés et les gains/pertes de wetland dans la Commune de Zorra entre 1978 et 1997. Les sources de données ont inclu le drainage classe, les dossiers d'évaluation de wetland, la photographie aérienne, et les entretiens avec les fonctionnaires. Les résultats indiquent que pendant que les mesures de réduction recommandées d'arrangements de drainage à proximité de wetlands ont augmenté, les pertes cumulatives continuent à arriver. Les règlements négociés parmi les ingénieurs de drainage et les agences de référence ont l'air d'être inadéquats sur le plan de maintenir les secteurs de wetland. L'approche régulatrice ne motive pas des changements dans les pratiques de direction d'usage de terre. Ceci soutient le besoin d'inclure des encouragements nonrégulateurs dans l'effort pour protéger wetlands. [source] International medical graduates: Learning for practice in Alberta, CanadaTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 3 2007Jocelyn Lockyer PhD Abstract Introduction: There is little known about the learning that is undertaken by physicians who graduate from a World Health Organization,listed medical school outside Canada and who migrate to Canada to practice. What do physicians learn and what resources do they access in adapting to practice in Alberta, a province of Canada? Methods: Telephone interviews with a theoretical sample of 19 IMG physicians were analyzed using a grounded theory constant comparative approach to develop categories, central themes, and a descriptive model. Results: The physicians described two types of learning: learning associated with studying for Canadian examinations required to remain and practice in the province and learning that was required to succeed at clinical work in a new setting. This second type of learning included regulations and systems, patient expectations, new disease profiles, new medications, new diagnostic procedures, and managing the referral process. The physicians "settled" into their new setting with the help of colleagues; the Internet, personal digital assistants (PDAs), and computers; reading; and continuing medical education programs. Patients both stimulated learning and were a resource for learning. Discussion: Settling into Alberta, Canada, physicians accommodated and adjusted to their settings with learning activities related to the clinical problems and situations that presented themselves. Collegial support in host communities appeared to be a critical dimension in how well physicians adjusted. The results suggest that mentoring programs may be a way of facilitating settlement. [source] Functional analysis and habit-reversal treatment of ticsBEHAVIORAL INTERVENTIONS, Issue 3 2005James E. Carr Although there is empirical support for a biological etiology of Tourette syndrome and other tic disorders, researchers have recently begun examining the role of reinforcement in tic maintenance. Using experimental functional analyses, researchers have identified both social and nonsocial functions for the tics of a variety of individuals. However, there are at least two problems with this developing literature. First, all but one of the studies employed a single participant and many of them were referred for clinical treatment. These factors leave open the possibility that the selection or referral process may have contributed to the reported outcomes. Second, five of the seven participants had a developmental disability or delay. Thus, the majority of participants in this literature are unrepresentative of most individuals with tic disorders. The purpose of the present study was to investigate the operant functions of the tics of multiple children who were recruited for the study. We evaluated the tics of three typically developing children using functional analysis. Results indicated nonsocial functions for all tics. Two of the participants were then treated using habit reversal; both of them experienced tic reductions. Copyright © 2005 John Wiley & Sons, Ltd. [source] Expectations and experience of labial reduction: a qualitative studyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2007R Bramwell Objective, To understand women's reasons for undergoing labial reduction surgery, their expectations and experiences. Design, A retrospective qualitative study. Setting, British National Health Service Hospital. Sample, Six women who had experienced surgery for labial reduction. Method, Qualitative study using semi-structured interviews. Results, Results relating to ,Normality and defect', ,Sex lives' and ,The process of accessing surgery' are presented in this study. The women had seen their presurgery genital appearance as ,defective' and sought a ,normal' genital appearance. They thought that their presurgery genital appearance impacted on their sex lives, but their expectations of the effects of surgery on their sex lives were not all fulfilled. Information about labial surgery came from both the popular media and the health services. An emphasis on, for example, physical discomfort rather than appearance may have been used to legitimise a request for surgery. The process of accessing surgery had exposed them to potentially conflicting messages about their genital appearance. Conclusions, Women presenting for labial reduction may have unrealistic expectations of surgery, but their perceptions and expectations are long-standing and seem to be based on strong cultural norms. The gynaecologist is also meeting those women who have already negotiated the referral process. As demand for this surgery appears to be increasing, further research is needed. These findings may add to the case for the potential value of specialist staff to provide psychosocial interventions within gynaecology services. [source] Testing the effect of including oral health in general health checks for elderly patients in medical practice , a randomized controlled trialCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 1 2007C. Lowe Abstract,,, Aim:, To test the feasibility and effectiveness of an oral health referral process for elderly patients (aged 75 years or over) attending a preventive health check (PHC) with their general medical practitioner. Objectives:, To evaluate the effectiveness of the process in increasing dental attendance at baseline and 6 months after the intervention. To identify key characteristics of those who accepted an oral health visit (OHV). To determine the proportion of people attending the OHV who required treatment and subsequently attended a dentist. Setting:, Three general medical practices in east Cheshire, UK. Design:, A randomized controlled trial. Method:, Elderly patients attending their general medical practice for PHCs were randomly assigned to a test group, who were invited to attend for an OHV, and to a control group, who received no intervention. Six months after the PHC the effectiveness of the process was measured. Results:, Some 50% of those invited for an OHV accepted. Those accepting were more likely to be edentulous, wear dentures or have a current oral health problem, than those declining. Regression analysis showed the best predictors of acceptance to be having a current dental problem or pain and not having a regular dentist. The mean time since their last dental visit was 8.1 years which was significantly longer than those declining the OHV. 63% of individuals attending the OHV were assessed as having a realistic treatment need and 70% of those referred went on to complete the course of treatment. In the test group a highly significant increase in reported dental visiting was found at sixth month evaluation. The primary care staff were happy to include the dental checklist and felt it was a valuable addition to the PHC. Conclusions:, The offer of an OHV was taken up most readily by those with current oral problems, or pain and those with no regular dentist. The inclusion of a dental checklist within the PHC for elderly patients together with help with arranging a dental appointment shows promise as a way of ensuring the dental needs of this group are met. [source] Religious Involvement and the Use of Mental Health CareHEALTH SERVICES RESEARCH, Issue 2 2006Katherine M. Harris Objectives. To examine the association between religious involvement and mental health care use by adults age 18 or older with mental health problems. Methods. We used data from the 2001,2003 National Surveys on Drug Use and Health. We defined two subgroups with moderate (n=49,902) and serious mental or emotional distress (n=14,548). For each subgroup, we estimated a series of bivariate probit models of past year use of outpatient care and prescription medications using indicators of the frequency of religious service attendance and two measures of the strength and influence of religious beliefs as independent variables. Covariates included common Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, disorders symptoms, substance use and related disorders, self-rated health status, and sociodemographic characteristics. Results. Among those with moderate distress, we found some evidence of a positive relationship between religious service attendance and outpatient mental health care use and of a negative relationship between the importance of religious beliefs and outpatient use. Among those with serious distress, use of outpatient care and medication was more strongly associated with service attendance and with the importance of religious beliefs. By contrast, we found a negative association between outpatient use and the influence of religious beliefs on decisions. Conclusion. The positive relationship between religious service participation and service use for those with serious distress suggests that policy initiatives aimed at increasing the timely and appropriate use of mental health care may be able to build upon structures and referral processes that currently exist in many religious organizations. [source] Psychiatric disorders and the use of mental health services among children involved in bullyingAGGRESSIVE BEHAVIOR, Issue 2 2001Kirsti Kumpulainen Abstract This study had two aims: to evaluate the relationship between bullying and psychiatric disorders and to study the probability of using mental health services among children involved in bully/victim problems. The data consisted of interviews with 423 parents and 420 children. Diagnostic measures were based on the Isle of Wight Interview. Children involved in bullying as bullies, bully-victims, and victims were compared with other children. Children involved in bully/victim problems were more prone to have psychiatric disorders than noninvolved children. The probability of being disturbed was highest among male bullies, followed by male bully-victims and female victims (9.5-fold, 7.9-fold, and 4.3-fold, respectively) compared with noninvolved same-sex children. The most common diagnoses among children involved in bully/victim problems were attention deficit disorder, oppositional/conduct disorder, and depression. Furthermore, children involved in bully/victim problems were more likely to have used mental health services at some time during their lives and also during the previous 3 months. Special attention should be paid to children's mental health when dealing with bullying problems at school. Referral pathways to mental health services and factors affecting the referral processes among children should be further studied. Aggr. Behav. 27:102,110, 2001. © 2001 Wiley-Liss, Inc. [source] | ||||||||||||||||