Referral for 'prostatism': developing a 'performance indicator' for the threshold between primary and secondary care?
TL;DR: The study demonstrated that more than a third of GPs do not report the results of digital rectal examination in their referrals and only 4% record urinary flow rates and post-micturition residual urine volume.
read more
Abstract: Objective. We aimed to define a performance indicator at the gateway between primary and secondary care.
Method. We carried out an analysis of referral letters sent to an urological department within the catchment area of a teaching hospital in Cardiff, Wales. The subjects were 221 sequential referral letters from 221 GPs. The main outcome measures were the information content of referral letters analysed. Letters were stratified into referral threshold groups by the presence of history, examination, routine investigations and specialized investigations.
Results. Three distinct categories of referral practice were identified: referrals which contained history alone; those providing history examination and a selection of routine investigations; and those providing history, examination data and the results of routine and specialized investigations. The study demonstrated that more than a third of GPs do not report the results of digital rectal examination in their referrals and only 4% record urinary flow rates and post-micturition residual urine volume.
Conclusions. The majority (60%) of generalist referrals to an urology department for prostatism provide enough information for specialists to be able to prioritize appointments, but more than a third (36%) of the referrals contain inadequate information. The method has the potential of being developed into a gateway performance indicator in clinical practice.
read more
Chat with Paper
AI Agents for this Paper
Find similar papers on Google Scholar, PubMed and Arxiv
Write a critical review of this paper
Analyze citations of this paper to find unaddressed research gaps
Citations
Avoidable referrals? Analysis of170consecutivereferrals to secondary care
NigelC H Stott
- 01 Jan 1994
TL;DR: Many theoretically avoidable referrals were due to managers' and politicians' decisions about allocation of resources, but some inappropriate referrals could be avoided by assessment of general practioners' needs for further knowledge and skills.
66
Copying referral letters to patients: the views of patients, patient representatives and doctors
TL;DR: There was general agreement that copying referral letters to patients could improve information and decision sharing with patients, but there were concerns about letter content, particularly medical terminology, character judgements and "sensitive" patient information.
32
Shared care and the management of lower urinary tract symptoms.
TL;DR: To investigate associations between the level of shared care and the clinical management of patients with uncomplicated lower urinary tract symptoms (LUTS), a large number of patients were referred to the hospital for shared care.
7
Diagnostic procedures by Italian general practitioners in response to lower urinary tract symptoms in male patients: a prospective study
Sebastiano Spatafora,Giorgio Canepa,Roberto Migliari,Salvatore Rotondo,Alberto Mandressi,Paolo Puppo +5 more
TL;DR: It is shown a propensity for the majority of Italian GPs to deal with LUTS patients in a primary setting without immediate referral to the urologist, and this trend could be beneficial for the patient and cost saving for the national health system.
4
References
The Challenges of Medical Practice Variations
Tavs Folmer Andersen,Gavin Mooney +1 more
- 01 Jan 1990
TL;DR: This chapter discusses medical practice Variations from a Lay Perspective, as well as challenges facing Modern Health Care and the Prospects for the Evaluative Clinical Sciences.
Some observations on attempts to measure appropriateness of care.
TL;DR: There are considerable uncertainties about the measure's meaning, the magnitude of bias that it contains, and the degree to which its application can be generalised, and some of these uncertainties could be resolved if the tacit assumptions inherent in the generation of the criteria could be made explicit.
148
Appropriateness: the next frontier
TL;DR: The health care systems of developed countries share common problems: the explosion of costly medical technologies increasingly jeopardises the authors' ability to give everybody all the care that would benefit them and society's ability to maintain universal insurance coverage may disappear.
Avoidable referrals? Analysis of170consecutivereferrals to secondary care
NigelC H Stott
- 01 Jan 1994
TL;DR: Many theoretically avoidable referrals were due to managers' and politicians' decisions about allocation of resources, but some inappropriate referrals could be avoided by assessment of general practioners' needs for further knowledge and skills.
66