Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial
Background: The referral letter is an important document facilitating the transfer of care from a general practitioner (GP) to secondary care. Hospital doctors have often criticised the quality and content of referral letters, and the effectiveness of improvement efforts remains uncertain. Methods:...
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ftunivtroemsoe:oai:munin.uit.no:10037/8830 2023-05-15T17:39:24+02:00 Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial Wåhlberg, Henrik Valle, Per Christian Malm, Siri Broderstad, Ann Ragnhild 2015-08-29 https://hdl.handle.net/10037/8830 https://doi.org/10.1186/s12913-015-1017-7 eng eng BioMed Central Wåhlberg, H. (2019). Practical health co-operation – a cluster randomised study. The impact of referral templates on quality of care and health care co-operation between primary and secondary care. (Doctoral thesis). https://hdl.handle.net/10037/17094 . BMC Health Services Research (2015) 15:353 FRIDAID 1262466 doi:10.1186/s12913-015-1017-7 1472-6963 https://hdl.handle.net/10037/8830 URN:NBN:no-uit_munin_8408 openAccess VDP::Medisinske Fag: 700::Helsefag: 800::Helsetjeneste- og helseadministrasjonsforskning: 806 VDP::Medical disciplines: 700::Health sciences: 800::Health service and health administration research: 806 Journal article Tidsskriftartikkel Peer reviewed 2015 ftunivtroemsoe https://doi.org/10.1186/s12913-015-1017-7 2021-06-25T17:54:35Z Background: The referral letter is an important document facilitating the transfer of care from a general practitioner (GP) to secondary care. Hospital doctors have often criticised the quality and content of referral letters, and the effectiveness of improvement efforts remains uncertain. Methods: A cluster randomised trial was conducted using referral templates for patients in four diagnostic groups: dyspepsia, suspected colorectal cancer, chest pain and chronic obstructive pulmonary disease. The GP surgery was the unit of randomisation. Of the 14 surgeries served by the University Hospital of North Norway Harstad, seven were randomised to the intervention group. Intervention GPs used referral templates soliciting core clinical information when initiating a new referral in one of the four clinical areas. Intermittent surgery visits by study personnel were also carried out. A total of 500 patients were included, with 281 in the intervention and 219 in the control arm. Referral quality scoring was performed by three blinded raters. Data were analysed using multi-level regression modelling. All analyses were conducted on intention-to-treat basis. Results: In the final multilevel model, referrals in the intervention group scored 18 % higher (95 % CI (11 %, 25 %), p < 0.001) on the referral quality score than the control group. The model also showed that board certified GPs and GPs in larger surgeries produced referrals of significantly higher quality. Conclusion: In this study, the dissemination of referral templates coupled with intermittent surgery visits produced higher quality referrals. Trial registration: This trial has been registered at ClinicalTrials.gov. The trial registration number is NCT01470963. Article in Journal/Newspaper North Norway University of Tromsø: Munin Open Research Archive Norway BMC Health Services Research 15 1 |
institution |
Open Polar |
collection |
University of Tromsø: Munin Open Research Archive |
op_collection_id |
ftunivtroemsoe |
language |
English |
topic |
VDP::Medisinske Fag: 700::Helsefag: 800::Helsetjeneste- og helseadministrasjonsforskning: 806 VDP::Medical disciplines: 700::Health sciences: 800::Health service and health administration research: 806 |
spellingShingle |
VDP::Medisinske Fag: 700::Helsefag: 800::Helsetjeneste- og helseadministrasjonsforskning: 806 VDP::Medical disciplines: 700::Health sciences: 800::Health service and health administration research: 806 Wåhlberg, Henrik Valle, Per Christian Malm, Siri Broderstad, Ann Ragnhild Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial |
topic_facet |
VDP::Medisinske Fag: 700::Helsefag: 800::Helsetjeneste- og helseadministrasjonsforskning: 806 VDP::Medical disciplines: 700::Health sciences: 800::Health service and health administration research: 806 |
description |
Background: The referral letter is an important document facilitating the transfer of care from a general practitioner (GP) to secondary care. Hospital doctors have often criticised the quality and content of referral letters, and the effectiveness of improvement efforts remains uncertain. Methods: A cluster randomised trial was conducted using referral templates for patients in four diagnostic groups: dyspepsia, suspected colorectal cancer, chest pain and chronic obstructive pulmonary disease. The GP surgery was the unit of randomisation. Of the 14 surgeries served by the University Hospital of North Norway Harstad, seven were randomised to the intervention group. Intervention GPs used referral templates soliciting core clinical information when initiating a new referral in one of the four clinical areas. Intermittent surgery visits by study personnel were also carried out. A total of 500 patients were included, with 281 in the intervention and 219 in the control arm. Referral quality scoring was performed by three blinded raters. Data were analysed using multi-level regression modelling. All analyses were conducted on intention-to-treat basis. Results: In the final multilevel model, referrals in the intervention group scored 18 % higher (95 % CI (11 %, 25 %), p < 0.001) on the referral quality score than the control group. The model also showed that board certified GPs and GPs in larger surgeries produced referrals of significantly higher quality. Conclusion: In this study, the dissemination of referral templates coupled with intermittent surgery visits produced higher quality referrals. Trial registration: This trial has been registered at ClinicalTrials.gov. The trial registration number is NCT01470963. |
format |
Article in Journal/Newspaper |
author |
Wåhlberg, Henrik Valle, Per Christian Malm, Siri Broderstad, Ann Ragnhild |
author_facet |
Wåhlberg, Henrik Valle, Per Christian Malm, Siri Broderstad, Ann Ragnhild |
author_sort |
Wåhlberg, Henrik |
title |
Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial |
title_short |
Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial |
title_full |
Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial |
title_fullStr |
Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial |
title_full_unstemmed |
Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial |
title_sort |
impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial |
publisher |
BioMed Central |
publishDate |
2015 |
url |
https://hdl.handle.net/10037/8830 https://doi.org/10.1186/s12913-015-1017-7 |
geographic |
Norway |
geographic_facet |
Norway |
genre |
North Norway |
genre_facet |
North Norway |
op_relation |
Wåhlberg, H. (2019). Practical health co-operation – a cluster randomised study. The impact of referral templates on quality of care and health care co-operation between primary and secondary care. (Doctoral thesis). https://hdl.handle.net/10037/17094 . BMC Health Services Research (2015) 15:353 FRIDAID 1262466 doi:10.1186/s12913-015-1017-7 1472-6963 https://hdl.handle.net/10037/8830 URN:NBN:no-uit_munin_8408 |
op_rights |
openAccess |
op_doi |
https://doi.org/10.1186/s12913-015-1017-7 |
container_title |
BMC Health Services Research |
container_volume |
15 |
container_issue |
1 |
_version_ |
1766140160666238976 |