Out-of-hours organisations are responsible for the care of patients 70% of the time, and their GPs act as gatekeepers to secondary care services. This observational study identifies the variations in GPs' out-of-hours referral rates to secondary care and factors that could explain these variations. One hundred and forty-nine GPs who worked in one UK general practice out-of-hours cooperative whi...

INTRODUCTION Referrals to nephrologists comprise not only patients with chronic kidney disease but also those with other nephrological conditions. There may be confusion about when to refer a patient to a nephrologist. We conducted a literature review to identify preexisting priority-setting, triage or referral criteria developed to guide referrals from primary care to a nephrologist. METHODS...

BACKGROUND Questionnaires completed respectively by doctor and patient may give conflicting views of what actions the doctor took during a consultation in primary care. This disagreement will affect an assessment of whether patient expectations of care were met, and may itself be influenced by fulfillment of expectations. OBJECTIVE To investigate how patient expectations, and patient and doct...

Our objective in this study was to review the experience of a one-stop multidisciplinary bone metastases clinic (BMC) that offers a coordinated multidisciplinary approach to the care of cancer patients with bone metastases in a tertiary cancer centre. Patients with symptomatic bone metastases were referred to BMC and assessed by a team of specialists in various disciplines - interventional radi...

BACKGROUND No literature exists which examines referral preferences to, or the consultation process with, Otolaryngology. In a recent Canadian Medical Association nation-wide survey of General Practitioners and Family Physicians, Otolaryngology was listed as the second-most problematic specialty for referrals. The purpose of this study was to learn about and improve upon the referral process be...

OBJECTIVE To present a pediatric psychology consultation treatment framework based on family systems and developmental theories. METHODS After reviewing background relevant to family systems interventions, a five-step protocol (referral, assessment, collaboration, outcome) for consultation is presented, using case examples from our pediatric oncology service, to illustrate joining, focusing, ...

The objective of this study was to analyse pattern of referral to Restorative Dentistry Consultation Clinics in a Dental Teaching Hospital. Patient demographic details and referral information were collected on new patient clinics. The majority of patients were female (62.1%). The greatest proportion of patients, 41.6%, was referred from the adjacent urban area. The highest percentage of referr...

BACKGROUND Under-diagnosis of pain is a serious problem in cancer care. Accurate pain assessment by physicians may form the basis of effective care. The aim of this study is to examine the association between late referral to a Palliative Care Team (PCT) after admission and the under-diagnosis of pain by primary physicians. METHODS This retrospective study was performed in the Teikyo Universi...

OBJECTIVE In response to limitations in access to subspecialty care, I present personal observations and suggestions related to education of future pediatricians regarding development of critical thinking skills, care of complex and chronically ill patients, development of empathy, and restoration of responsibility that may help ameliorate this serious problem. Toward this end, I also offer 1 a...