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Interventions to improve outpatient referrals from primary care to secondary care

Overview of attention for article published in Cochrane database of systematic reviews, October 2008
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • Good Attention Score compared to outputs of the same age (78th percentile)
  • Average Attention Score compared to outputs of the same age and source

Mentioned by

policy
1 policy source
twitter
4 tweeters

Citations

dimensions_citation
203 Dimensions

Readers on

mendeley
247 Mendeley
citeulike
1 CiteULike
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Title
Interventions to improve outpatient referrals from primary care to secondary care
Published in
Cochrane database of systematic reviews, October 2008
DOI 10.1002/14651858.cd005471.pub2
Pubmed ID
Authors

Ayub Akbari, Alain Mayhew, Manal Alawi Al-Alawi, Jeremy Grimshaw, Ron Winkens, Elizabeth Glidewell, Chanie Pritchard, Ruth Thomas, Cynthia Fraser

Abstract

The primary care specialist interface is a key organisational feature of many health care systems. Patients are referred to specialist care when investigation or therapeutic options are exhausted in primary care and more specialised care is needed. Referral has considerable implications for patients, the health care system and health care costs. There is considerable evidence that the referral processes can be improved. To estimate the effectiveness and efficiency of interventions to change outpatient referral rates or improve outpatient referral appropriateness. We conducted electronic searches of the Cochrane Effective Practice and Organisation of Care (EPOC) group specialised register (developed through extensive searches of MEDLINE, EMBASE, Healthstar and the Cochrane Library) (February 2002) and the National Research Register. Updated searches were conducted in MEDLINE and the EPOC specialised register up to October 2007. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of interventions to change or improve outpatient referrals. Participants were primary care physicians. The outcomes were objectively measured provider performance or health outcomes. A minimum of two reviewers independently extracted data and assessed study quality. Seventeen studies involving 23 separate comparisons were included. Nine studies (14 comparisons) evaluated professional educational interventions. Ineffective strategies included: passive dissemination of local referral guidelines (two studies), feedback of referral rates (one study) and discussion with an independent medical adviser (one study). Generally effective strategies included dissemination of guidelines with structured referral sheets (four out of five studies) and involvement of consultants in educational activities (two out of three studies). Four studies evaluated organisational interventions (patient management by family physicians compared to general internists, attachment of a physiotherapist to general practices, a new slot system for referrals and requiring a second 'in-house' opinion prior to referral), all of which were effective. Four studies (five comparisons) evaluated financial interventions. One study evaluating change from a capitation based to mixed capitation and fee-for-service system and from a fee-for-service to a capitation based system (with an element of risk sharing for secondary care services) observed a reduction in referral rates. Modest reductions in referral rates of uncertain significance were observed following the introduction of the general practice fundholding scheme in the United Kingdom (UK). One study evaluating the effect of providing access to private specialists demonstrated an increase in the proportion of patients referred to specialist services but no overall effect on referral rates. There are a limited number of rigorous evaluations to base policy on. Active local educational interventions involving secondary care specialists and structured referral sheets are the only interventions shown to impact on referral rates based on current evidence. The effects of 'in-house' second opinion and other intermediate primary care based alternatives to outpatient referral appear promising.

Twitter Demographics

The data shown below were collected from the profiles of 4 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 247 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 3 1%
Austria 2 <1%
United States 2 <1%
Brazil 2 <1%
Israel 1 <1%
Australia 1 <1%
Canada 1 <1%
Denmark 1 <1%
Spain 1 <1%
Other 1 <1%
Unknown 232 94%

Demographic breakdown

Readers by professional status Count As %
Student > Master 61 25%
Researcher 51 21%
Student > Ph. D. Student 22 9%
Student > Doctoral Student 17 7%
Student > Bachelor 17 7%
Other 47 19%
Unknown 32 13%
Readers by discipline Count As %
Medicine and Dentistry 113 46%
Nursing and Health Professions 23 9%
Social Sciences 21 9%
Economics, Econometrics and Finance 10 4%
Psychology 8 3%
Other 23 9%
Unknown 49 20%

Attention Score in Context

This research output has an Altmetric Attention Score of 6. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 July 2020.
All research outputs
#3,756,457
of 15,576,437 outputs
Outputs from Cochrane database of systematic reviews
#6,212
of 11,219 outputs
Outputs of similar age
#45,554
of 210,954 outputs
Outputs of similar age from Cochrane database of systematic reviews
#139
of 216 outputs
Altmetric has tracked 15,576,437 research outputs across all sources so far. Compared to these this one has done well and is in the 75th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 11,219 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 23.3. This one is in the 44th percentile – i.e., 44% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 210,954 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 78% of its contemporaries.
We're also able to compare this research output to 216 others from the same source and published within six weeks on either side of this one. This one is in the 33rd percentile – i.e., 33% of its contemporaries scored the same or lower than it.