A public health intervention package for increasing tuberculosis notifications from private practitioners in Bandung, Indonesia (INSTEP2): A cluster-randomised controlled trial protocol
Panji Fortuna HadisoemartoBony Wiem LestariKatrina SharplesNur AfifahLidya ChaidirChuan-Chin HuangSusan McAllisterReinout van CrevelMegan MurrayBachti AlisjahbanaPhilip C. Hill
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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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Objective To investigate the role of referral doctors in enhancement of referral arrival rate of pulmonary tuber culosis patients.Methods Two counties with low referral arrival rate of tuberculosis cases were selected as the intervention county and the control county.Health education was implemented in intervention county with tuberculosis patients required re ferral,while the control county maintained the original operating mode,and then 150 tuberculosis cases reported by medical in stitutions in the two counties were investigated by questionnaire survey.Results The referral arrival rate of tuberculosis pa tients in intervention county increased from 23.8% to 66.7%,significantly higher than that before intervention(χ2 = 83.7,P 0.05) and also significantly higher than in control county(41.3%,χ2 = 19.38,P0.05).Besides,81.3% of patients in interven tion county obtained the TB control knowledge from health education by referral doctors before referral,significantly higher than that of control county(χ2 = 53.7).The cause of tuberculosis cases failed to referral was due to unfamiliar of TB control insti tutions accounted for 46.9%(intervention county) and 51.3%(control county),and the cause of other tuberculosis cases failed to referral was due to unclear explanation by the referral doctors accounted for 40.8% and 30.6% in the intervention county and control county,respectively.Conclusions Health education given by referral doctors before referral is one of the important measures for enhancing the referral arrival rate of tuberculosis patients.Thus the effort of upgrading the health education level of referral doctors is indicated.
Tuberculosis control
Tuberculosis prevention
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Background. In Saudi Arabia, the mortality of diabetes is currently reported at 6%. A well-administered referral system is crucial in aiding the management of this disease. Method. A single reviewer employed a systematic approach to searching the literature databases with regard to the question: what are the attributes of referral systems in Saudi Arabia for patients with type 2 diabetes (T2D)? The results were analysed in order to provide recommendations to improve the Saudi health system. Results. Twelve primary studies were identified from a systematic search. Overall, the 12 studies did not clearly mention any of the factors of a good referral system. The referral problems identified by this study included patients’ unnecessary requests for referral, unstructured referral letters, and unclear dissemination guidelines for referral. Conclusions. This research attempted to identify the efficiency of the referral processes that were implemented for patients with T2D. The majority of the included studies were completely silent on the main referral factors for patients. If this review is representative of the referral system in Saudi Arabia, then, in the context of T2D, current referrals are unsafe. Further research on the quality of the referral system, taking into account at least some of the WHO referral guidelines, is required.
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Objective To explore and discuss contradictions and problems existing in the two-way referral system through analyzing the situation of patients' referral between Sichuan Provincial People's Hospital and 21 community health service centers in Chengdu,and propose measures and methods to further improve the two-way referral system.Methods Totally 3652 patients required referral from April 2010 to March 2011(2 635 patients from the hospital to community medical service centers and 1017 in a opposite direction) were selected.The reasons for referral and the factors for successful and unsuccessful referral were analyzed.The on-site interviews were conducted among doctors,department directors,and medical administrators from both the hospital and the centers.The talking topics included the design of bi-directional referral system,policy support from the government,current status of two-way referral and the main factors restricting the implementation of bi-directional referral system.Results Among the 2635 patients needed to have a referral from the hospital to centers(downward referral) for rehabilitation only 50 were successfully transferred,with a successful referral ratio of 52.7∶ 1.However,concurrently 1017 patients were transferred from the 21 centers to the hospital(upward referral).The ratio of upward referral to downward referral was 20.3∶ 1.There are a total of 1623 beds in all the 21 centers,however,the average utilization rate of beds was only 70.65%,as contrasted with that of 112.35% in the hospital.Majority of the interviewers believed that the factors impacting the implementation of two-way referral included un-smooth communication of medical information,no criteria and process of referral so far,shortage of mutual trust between the two referral parties,and non-full consideration of the two-way referral factors by the medical authorities in formulating the local health plan.Conclusion Although the two-way referral system has been implemented in Chengdu area,the rate of successful transfer is still lower,especially for the patients needing downward referral.
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Referral rates and urgency of referral to hospital by six pairs of trainers and trainees were compared over one month in 1986. From 5846 consultations, 327 resulted in referral to hospital. Overall, the referral rates was low at 5.6 per 100 consultations; however, there was considerable variation in individual referral rates with trainees tending to follow their trainer's referral patterns, despite statistical adjustment for sharing the same practice. This paper critically examines the wisdom of using general practitioner referral rates for the purpose of resource allocation and education.
Trainer
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Objective To understand the present situation of medical referral in community health service (CHS) institutions of Beijing and the demands for referral criteria.Methods A questionnaire survey was conduced among trainees of training program for key general practitioners form CHS institutions in Beijing.Results The present situation of referral was unsatisfactory;with a lower referral rate.The major problems were unsmooth referral channel between the higher level hospital and CHS institutions,more up-referral from CHS institutions to higher-level hospital,and no unified referral criteria.General practitioners had an urgent demand for referral criteria.Conclusion In order to improve the two-way referral system,the referral guidelines and referral indicators or main symptoms of diseases for CHS institutions should be made as soon as possible.
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Objective: To explore the implementation and nursing experience of community two-way referral system.Methods: The referral rate and readmission rates of 240 cases patients were analyzed and discussed before and after the community two-way referral system,then gave the advice according to the results.Results: The referral rate of the patients after the community two-way referral system was 68.3%(82/120),which was higher than the rate before 30.8%(37/120),there was a significant difference between them(P0.01).The readmission rate also reduced after the community two-way referral system with it was from 63.7% to 22.1%.Conclusion: The performance of community two-way referral system is in favor of utilizing the medical resources reasonably.Meanwhile,it is benefit for the development of community hospital.
Community hospital
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The risk and timing of tuberculosis among recently exposed close contacts of patients with infectious tuberculosis are not well established.
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Objective To estimate the current status of the referral of tuberculosis patients in general hospitals in the hope of raising the rate of accomplished referral.Methods The data regarding the mechanism and status of tuberculosis patient referral in general hospitals in Dongying city of Shangdong province were collected and analyzed.Results Among the 200 TB cases selected for being inspected,177 cases were reported by the network report system,and the missing report rate was 11.5%.A total of 166 cases were referral,34 cases lost their referral with the rate of missing referral being 17%,and 133 cases completed their referral with the availability rate of referral being 67.9%.Conclusion Lack of referral or unaccomplished referral of tuberculosis patients both occurred in general hospitals,with the higher rate of accomplished referral being found in those occasions wherein a department was designated to be in charge of referral.
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History of tuberculosis
Tuberculosis diagnosis
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