Priority Setting and Waiting Time Decision in the Referral Process, How and by Whom? (Priority)

Priority Setting and Waiting Time Decision in the Referral Process, How and by Whom? A Prospective Cluster Randomized Controlled Trial on the Effects of an Education Program in Priority Setting and Waiting Time Decision in Referrals

The referral letter is used for different purposes: a request for a special diagnostic assessment or medical treatment that the GP cannot perform for the patient, an invitation to have a second opinion about a clinical problem or a wish for mutual responsibility for the medical handling. The individual referral rate between GPs varies greatly, and is an important determinant of secondary care utilization. We wanted to study the various elements and factors having an impact on the referral process, from the moment the GP decides to refer the patient until the hospital consultant assess the referral and prioritise the patient for further investigation or treatment. How and why are we, the GPs who refer, so different? We wanted to

1. identify and describe general practitioners' reflections on and attitudes to the referral process and cooperation with hospital specialists
2. identify and describe hospital consultants' reflections on and attitudes to the referral process and cooperation with general practitioners
3. identify typologies characterising GPs in the referral practice

Study Overview

• Status: Withdrawn
• Conditions: Communication

Detailed Description

Design and Methods:

We did two qualitative and one quantitative study. The first was a focus group study with GPs in CPD groups, the second an individual study with hospital consultants, both analyses by using systematic text condensation. The third was a quantitative registration of impressions, facts and feelings in the referral process using a principal component analysis to find typologies for GPs who refer to hospital.

Participants:

GPs referring to Stavanger University Hospital. Hospital consultants at Stavanger University Hospital.

Intervention: No intervention was performed.

Time schedule:

Data Collection finished May 2014.

• Study Type: Observational

Contacts and Locations

Study Locations

• Norway
  • Stavanger, Norway, 4001
    • Stavanger University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 25 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

General practitioners referring to Stavanger University Hospital

Description

Inclusion Criteria:

All the 300 GPs referring to Stavanger University Hospital who participate in one of the 58 CPD groups in South Rogaland County and who agree to participate in the study are included.

Exclusion Criteria:

GPs not willing to participate

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Prioritization; Team-based multifaceted interactive training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Use of priority setting and waiting time indication in referrals	The use of priority setting and waiting time in referrals will be recorded before and after an intervention with group training for general practitioners	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Referral rates	The referral rates may be reduced by higher awareness of non-prioritized medical conditions. The use of priority setting and waiting time according to the national prioritization guidelines can give a higher correlation between GPs and hospital consultants about priority setting and waiting time.	One year

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Inter-rater agreement between GPs and hospital consultants on priority setting and waiting time for patients	We will study the inter-rater correlation between GPs and hospital consultants about priority setting and waiting time for patients referred to hospital	One year

Collaborators and Investigators

• Sponsor: University of Bergen
• Investigators: Study Chair: Anders Baerheim, Professor, Department of Global Public Health and Primary Care, University of Bergen, Norway

Publications and helpful links

General Publications

• Thorsen O, Hartveit M, Baerheim A. General practitioners' reflections on referring: an asymmetric or non-dialogical process? Scand J Prim Health Care. 2012 Dec;30(4):241-6. doi: 10.3109/02813432.2012.711190. Epub 2012 Oct 10.

Study record dates

Study Major Dates

• Study Start: January 1, 2016
• Primary Completion (Actual): January 1, 2016
• Study Completion (Anticipated): October 10, 2018

Study Registration Dates

• First Submitted: October 17, 2013
• First Submitted That Met QC Criteria: October 29, 2013
• First Posted (Estimate): November 5, 2013

Study Record Updates

• Last Update Posted (Actual): October 1, 2021
• Last Update Submitted That Met QC Criteria: September 28, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Keywords: Priority setting; Comprehensive referrals; Appropriate referring; Waiting time in hospital
• Other Study ID Numbers: REK2013/1762

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO