Screening of Hemoglobin Disorders in Referral Cases to the Hospital’s Laboratory in Northeast Iran
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Determining the frequencies of hemoglobin disorders in referral cases to the hospital's laboratory for designing the best program for prevention, early diagnosis and treatment of these disorders.Hemoglobin electrophoresis and CBC were performed on 6033 cases referred to Imam Reza hospital, Mashhad, Iran from 2004 to 2009.Normal and abnormal electrophoretic patterns were identified in 77.55% (4679 cases) and 22.44% (1354 cases), respectively.The most common hemoglobin disorders, in order of frequency, were ß-thalassemia minor (19.44%),Hb D (1.63%), Hb S (0.38%), thalassemia intermedia to major (0.24%), thalassemia major (0.23%), δß 0 -thalassemia (heterozygous) (0.18%), hereditary persistence of fetal hemoglobin (heterozygous) (0.1%), Hb H (0.1%), Hb C,E or O (0.07%), HbLepor (heterozygous) (0.03%), Hb D/ß + -thalassemia (0.02%) and Hb S/ß + -thalassemia (0.02%).Based on our study hemoglobin disorders are a common problem in this region as the abnormal results in electrophoresis were observed in the 22.44% of individuals.These results show the importance of a premarital screening program for hemoglobin disorders in this geographic area.Background: After the referral system had been established, a tendency of patients who prefer to consult themselves to a specialist with 'self requested referral' is increasing in university hospital family medicine clinics.This study was conducted to know which factors of patients who for the fi rst time visited university hospital family medicine clinic to require medical request for 'self requested referral' to a specialist infl uence 'self requested referral' tendency.Methods: Among 905 patients, 647 agreed to the questionnaire were included in this study.We divided the patients in two, the 'self requested referral' group and the 'general patients' group that does not.Patients completed a four-item, selfadministered questionnaire.Results: 'Self requested referral' group tended to have no experience in family medicine and tended to be negative about the need for family medicine (P < 0.001) The factors that have effect on 'self requested referral' are age, occupation, education, experience of family medicine, and recognition degree of necessity of family medicine.Patients in 20-39 of age, who were white colored, higher education had higher tendency of 'self requested referral' and patients who had no experience in family medicine and lower degree of recognition about the necessity of family medicine had higher tendency of 'self-referral'. Conclusion:It is necessary to fi nd ways to increase satisfaction of patients who have factors that have effect on their 'self requested referral' tendency such as age, occupation, education, experience of family medicine, and degree of recognition about the necessity of family medicine.
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To describe the general practitioners referral patterns. There is special emphasis in the delay between the referral and the first consultation with the specialist. Also we consider other aspects of the coordination between both levels of care.Cross-sectional study upon 8.095 referrals from 242 spanish doctors.The referral rate was 6.63%, higher in the 15-44 age group and also for men. We find a huge variability in the referral rates among doctors. The referral rates are higher to surgical specialties. The mean delay between referral and specialist appointment was 11 days. The general practitioners didn't receive communication from the specialists in 23.5 of the referrals.A considerable range of referral rates has been identified. There is a poor continuity and coordination in the patient care.
Patient referral
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Background: As the first in the line of contacts between patients and the health system, family physicians have an important role in improving the health status of a society. Referring the patients to specialized care or special health services is one of the important duties for this group. Objective: To better understand referral services, this study aimed at evaluating the referral function of family physicians in Damavand City. Materials and methods: This cross-sectional descriptive study was carried out in five health care centers with eight family physicians in Damavand City from April to September 2013. The main variables included the number of referred patients to laboratory and radiology centers and specialist physicians and the provided feedback. Results: The findings revealed that three out of eight family physicians referred patients to the laboratory more than the set cap. As for referrals to specialists, only one physician had more than ten percent of the cap. The feedback was zero for all patients, except for one case who had unknown status and another who had five percent feedback. Conclusions: According to the results, it can be concluded that the existing referral potential is not optimally fulfilled by family physicians of Damavand City. Increasing the usage of the available potentials is hence recommended. Key Words: Referral System, Family Physicians, Damavand
Family health
Cross-sectional study
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Despite the fact that the proportion of immigrant and minority women who consult a general practitioner about their health is similar to that of their Canadian-born counterparts, studies suggest that they are less likely to be screened for breast cancer. This study examines physician characteristics associated with mammography referral and perceived barriers to mammography among family physicians serving the Caribbean community of Toronto.The study consisted of a mail-back family physician survey.Among the 64 physicians who responded to the survey, over half reported that they were "very likely" to refer women for mammography during a regular preventive check-up. Among physician variables, only the amount of time spent on patient education was significantly associated with the likelihood of referral. Regarding perceived barriers, for male physicians, patient refusal and intervention causing patient discomfort were significantly associated with referral. For female physicians, only forgetting to provide service was identified as a significant barrier to referral.An increased emphasis on patient education may help to increase screening referral among all physicians. Gender differences in perceived barriers to referral suggest that the gender of the physician is of major importance to the Caribbean community.
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In many countries, the referral-consultation process faces a number of challenges from inefficiencies and rising demand, resulting in excessive wait times for many specialties. We collected referral data from a sample of family doctors across the province of Ontario, Canada as part of a larger program of research. The purpose of this study is to describe referral patterns from primary care to specialist and allied health services from the primary care perspective.We conducted a prospective study of patient referral data submitted by primary care providers (PCP) from 20 clinics across Ontario between June 2014 and January 2016. Monthly referral volumes expressed as a total number of referrals to all medical and allied health professionals per month. For each referral, we also collected data on the specialty type, reason for referral, and whether the referral was for a procedure.PCPs submitted a median of 26 referrals per month (interquartile range 11.5 to 31.8). Of 9509 referrals eligible for analysis, 97.8% were directed to medical professionals and 2.2% to allied health professionals. 55% of medical referrals were directed to non-surgical specialties and 44.8% to surgical specialties. Medical referrals were for procedures in 30.8% of cases and non-procedural in 40.9%. Gastroenterology received the largest share (11.2%) of medical referrals, of which 62.3% were for colonoscopies. Psychology received the largest share (28.3%) of referrals to allied health professionals.We described patterns of patient referral from primary care to specialist and allied health services for 30 PCPs in 20 clinics across Ontario. Gastroenterology received the largest share of referrals, nearly two-thirds of which were for colonoscopies. Future studies should explore the use of virtual care to help manage non-procedural referrals and examine the impact that procedural referrals have on wait times for gastroenterology.
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OBJECTIVES--To determine the extent to which variation in rates of referral among general practitioners may be explained by inappropriate referrals and to estimate the effect of implementing referral guidelines. SETTING--Practices within Cambridge Health Authority and Addenbrooke9s Hospital, Cambridge. MAIN OUTCOME MEASURES--Data on practice referral rates from hospital computers, inappropriate referrals as judged by hospital consultants, and inappropriate referrals as judged against referral guidelines which had been developed locally between general practitioners and specialists. Effect of referral guidelines on referral patterns as judged by general practitioners using the guidelines in clinical practice. RESULTS--There was 2.5-fold variation in referral rates among general practices. According to the specialists, 9.6% (95% confidence interval 6.4% to 12.9%) of referrals by general practitioners and 8.9% (2.6% to 15.2%) of referrals from other specialists were judged possibly or definitely inappropriate. Against locally determined referral guidelines 15.9% of referrals by general practitioners were judged possibly inappropriate (11.8% to 20.0%). Elimination of all possibly inappropriate referrals could reduce variation in practice referral rates only from 2.5-fold to 2.1-fold. An estimate of the effect of using referral guidelines for 60 common conditions in routine general practice suggested that application of guidelines would have been unlikely to reduce rates of referral in hospital (95% confidence interval -4.5% to 8.6% of consultations resulting in referral). CONCLUSION--The variation in referral rates among general practitioners in Cambridge could not be explained by inappropriate referrals. Application of referral guidelines would be unlikely to reduce the number of patients referred to hospital.
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To examine family physicians' referral decisions, which we conceptualized as having 2 phases: whether to refer followed by to whom to refer.Prospective cohort study.All visits (N = 34,519) and new referrals (N = 2534) occurring during 15 consecutive business days in the offices of 141 family physicians in 87 practices located in 31 states.Rates of referral, reasons for referral, practitioners referred to, health problems prompting referral, and reasons for selecting particular specialists.Approximately 1 in 20 (5.1%) office visits led to referral. Although 68% of referrals were made by physicians during office visits, 18% were made by physicians during telephone conversations with patients, 11% by office staff with input from the physician, and 3% by staff without physician input. Physicians endorsed a mean of 1.8 reasons for making a referral. They sought specialists' advice on either diagnosis or treatment for 52.1% of referrals and asked the specialist to direct medical management for 25.9% and surgical management for 37.8%. Patient request was one reason for 13.6% of referrals. Fifty conditions accounted for 76% of all referrals. Surgical specialists were sent the largest share of referrals (45.4%), followed by medical specialists (31.0%), nonphysician clinicians (12.1%), obstetrician-gynecologists (4.6%), mental health professionals (4.2%), other practitioners (2.0%), and generalists (0.8%). Physicians recommended a specific practitioner to the patient for most (86.2%) referrals. Personal knowledge of the specialist was the most important reason for selecting a specific specialist.Referrals are commonly made during encounters other than office visits, such as telephone conversations or staff-patient interactions, in primary care practice. Training in the referral process should ensure that family physicians obtain the skills necessary to expand their scope of practice, when appropriate; determine when and why a patient should be referred; and identify the type of practitioner to whom the patient should be sent.
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This study assessed Australian clinicians’ knowledge, attitudes and referral patterns of patients with suspected Lynch syndrome for genetic services. A total of 144 oncologists, surgeons, gynaecologists, general practitioners and gastroenterologists from the Australian Medical Association and Clinical Oncology Society responded to a web-based survey. Most respondents demonstrated suboptimal knowledge of Lynch syndrome. Male general practitioners who have been practicing for ≥10 years were less likely to offer genetic referral than specialists, and many clinicians did not recognize that immunohistochemistry testing is not a germline test. Half of all general practitioners did not actually refer patients in the past 12 months, and 30% of them did not feel that their role is to identify patients for genetic referral. The majority of clinicians considered everyone to be responsible for making the initial referral to genetic services, but a small preference was given to oncologists (15%) and general practitioners (13%). Patient information brochures, continuing genetic education programs and referral guidelines were favoured as support for practice. Targeted education interventions should be considered to improve referral. An online family history assessment tool with built-in decision support would be helpful in triaging high-risk individuals for pathology analysis and/or genetic assessment in general practice.
Lynch Syndrome
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