Impact of referral templates on patient experience of the referral and care process: a cluster randomised trial

• Published in: BMJ Open
• Main Authors: Wåhlberg, Henrik, Braaten, Tonje, Broderstad, Ann Ragnhild
• Other Authors: Helse Nord RHF
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMJ 2016
• Subjects: Norway; North Norway
• Online Access: http://dx.doi.org/10.1136/bmjopen-2016-011651; https://syndication.highwire.org/content/doi/10.1136/bmjopen-2016-011651

Objectives To evaluate if a referral intervention improves the patient experience of the referral and treatment process. Setting Interface between 14 primary care surgeries and a district general hospital. Participants The 14 general practitioner (GP) surgeries (7 intervention, 7 control) in the area around the University Hospital of North Norway Harstad were randomised and all completed the study. Consecutive individual patients were recruited at their hospital appointment. A total of 500 patients were recruited with 281 in the intervention and 219 in the control arm. Interventions Dissemination of referral templates for 4 diagnostic groups (dyspepsia, suspected colorectal cancer, chest pain and chronic obstructive pulmonary disease) coupled with intermittent surgery visits by study personnel. The control arm continued standard referral practice. The intervention was in use for 2.5 years. Outcome The main outcome was a quality indicator score. This paper reports a secondary outcome, the patient experience, as measured by self-report questionnaires. GPs in the intervention group could not be blinded. Patients were blinded to intervention status. Analysis was based on single-question comparison with a questionnaire subscore used to assess the effect of clustering. Results On the individual questions, overall satisfaction was very high with minor differences between the intervention and control group. Interestingly, the most negative responses, in both groups concerned questions relating to patient interaction and information. Very little evidence of clustering was found with an estimated intracluster correlations coefficient at 1.21e −11 . Conclusions In total, this indicates no clear effect of the implementation of referral templates on the patient experience, in a setting of generally high patient satisfaction. Trial registration number NCT01470963 Results.