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Cochrane Database of Systematic Reviews

Interventions to improve outpatient referrals from primary care to secondary care

Overview of attention for article published in Cochrane database of systematic reviews, October 2008
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • Good Attention Score compared to outputs of the same age (78th percentile)
  • Average Attention Score compared to outputs of the same age and source

Mentioned by

policy
1 policy source
twitter
4 tweeters

Citations

dimensions_citation
233 Dimensions

Readers on

mendeley
294 Mendeley
citeulike
1 CiteULike
Title
Interventions to improve outpatient referrals from primary care to secondary care
Published in
Cochrane database of systematic reviews, October 2008
DOI 10.1002/14651858.cd005471.pub2
Pubmed ID
Authors

Ayub Akbari, Alain Mayhew, Manal Alawi Al-Alawi, Jeremy Grimshaw, Ron Winkens, Elizabeth Glidewell, Chanie Pritchard, Ruth Thomas, Cynthia Fraser

Abstract

The primary care specialist interface is a key organisational feature of many health care systems. Patients are referred to specialist care when investigation or therapeutic options are exhausted in primary care and more specialised care is needed. Referral has considerable implications for patients, the health care system and health care costs. There is considerable evidence that the referral processes can be improved. To estimate the effectiveness and efficiency of interventions to change outpatient referral rates or improve outpatient referral appropriateness. We conducted electronic searches of the Cochrane Effective Practice and Organisation of Care (EPOC) group specialised register (developed through extensive searches of MEDLINE, EMBASE, Healthstar and the Cochrane Library) (February 2002) and the National Research Register. Updated searches were conducted in MEDLINE and the EPOC specialised register up to October 2007. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of interventions to change or improve outpatient referrals. Participants were primary care physicians. The outcomes were objectively measured provider performance or health outcomes. A minimum of two reviewers independently extracted data and assessed study quality. Seventeen studies involving 23 separate comparisons were included. Nine studies (14 comparisons) evaluated professional educational interventions. Ineffective strategies included: passive dissemination of local referral guidelines (two studies), feedback of referral rates (one study) and discussion with an independent medical adviser (one study). Generally effective strategies included dissemination of guidelines with structured referral sheets (four out of five studies) and involvement of consultants in educational activities (two out of three studies). Four studies evaluated organisational interventions (patient management by family physicians compared to general internists, attachment of a physiotherapist to general practices, a new slot system for referrals and requiring a second 'in-house' opinion prior to referral), all of which were effective. Four studies (five comparisons) evaluated financial interventions. One study evaluating change from a capitation based to mixed capitation and fee-for-service system and from a fee-for-service to a capitation based system (with an element of risk sharing for secondary care services) observed a reduction in referral rates. Modest reductions in referral rates of uncertain significance were observed following the introduction of the general practice fundholding scheme in the United Kingdom (UK). One study evaluating the effect of providing access to private specialists demonstrated an increase in the proportion of patients referred to specialist services but no overall effect on referral rates. There are a limited number of rigorous evaluations to base policy on. Active local educational interventions involving secondary care specialists and structured referral sheets are the only interventions shown to impact on referral rates based on current evidence. The effects of 'in-house' second opinion and other intermediate primary care based alternatives to outpatient referral appear promising.

Twitter Demographics

The data shown below were collected from the profiles of 4 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 294 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 3 1%
Austria 2 <1%
United States 2 <1%
Brazil 2 <1%
Israel 1 <1%
Australia 1 <1%
Canada 1 <1%
Denmark 1 <1%
Spain 1 <1%
Other 1 <1%
Unknown 279 95%

Demographic breakdown

Readers by professional status Count As %
Student > Master 63 21%
Researcher 55 19%
Student > Ph. D. Student 27 9%
Student > Bachelor 25 9%
Student > Doctoral Student 16 5%
Other 59 20%
Unknown 49 17%
Readers by discipline Count As %
Medicine and Dentistry 124 42%
Nursing and Health Professions 27 9%
Social Sciences 25 9%
Psychology 11 4%
Economics, Econometrics and Finance 11 4%
Other 30 10%
Unknown 66 22%

Attention Score in Context

This research output has an Altmetric Attention Score of 6. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 July 2020.
All research outputs
#4,472,267
of 18,430,950 outputs
Outputs from Cochrane database of systematic reviews
#6,683
of 11,829 outputs
Outputs of similar age
#47,817
of 218,833 outputs
Outputs of similar age from Cochrane database of systematic reviews
#135
of 215 outputs
Altmetric has tracked 18,430,950 research outputs across all sources so far. Compared to these this one has done well and is in the 75th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 11,829 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 25.6. This one is in the 43rd percentile – i.e., 43% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 218,833 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 78% of its contemporaries.
We're also able to compare this research output to 215 others from the same source and published within six weeks on either side of this one. This one is in the 36th percentile – i.e., 36% of its contemporaries scored the same or lower than it.