Referral interventions from primary to specialist care: A systematic review of international evidence

British Journal of General Practice

Volumn 64, Issue 629, 2014, Pages e765-e774

  Blank, Lindsay ^a   Baxter, Susan ^a   Woods, Helen Buckley ^a   Goyder, Elizabeth ^a   Lee, Andrew ^a   Payne, Nick ^a   Rimmer, Melanie ^a  

^a UNIVERSITY OF SHEFFIELD   (United Kingdom)

Author keywords

Demand management; General practice; Narrative synthesis; Primary care; Referral; Systematic review

Indexed keywords

ARTICLE; GENERAL PRACTITIONER; HEALTH CARE; HEALTH CARE MANAGEMENT; HUMAN; MEDICAL SPECIALIST; OUTCOME ASSESSMENT; PATIENT CARE; PATIENT REFERRAL; PRIMARY MEDICAL CARE; PUBLIC HEALTH; SECONDARY HEALTH CARE; SYSTEMATIC REVIEW; EVIDENCE BASED MEDICINE; HEALTH SERVICE; ORGANIZATION AND MANAGEMENT; PRACTICE GUIDELINE; PRIMARY HEALTH CARE; TREATMENT OUTCOME; UNITED KINGDOM;

EVIDENCE-BASED MEDICINE; GREAT BRITAIN; HEALTH SERVICES NEEDS AND DEMAND; HUMANS; OUTCOME AND PROCESS ASSESSMENT (HEALTH CARE); PRACTICE GUIDELINES AS TOPIC; PRIMARY HEALTH CARE; REFERRAL AND CONSULTATION; SECONDARY CARE;

EID: 84919397206     PISSN: 09601643     EISSN: 14785242     Source Type: Journal    
DOI: 10.3399/bjgp14X682837     Document Type: Article

References (151)

1. The King's Fund. An alternative guide to the new NHS in England. London: The King's Fund, 2013. http://www.kingsfund.org.uk/projects/nhs-65/alternativeguide-new-nhs-england (accessed 15 Oct 2014).
2. Jones NM, Charlesworth A. The anatomy of health spending 2011/12. London: Nuffield Trust, 2013. http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/130305-anatomy-health-spending.pdf (accessed 15 Oct 2014).
3. Lee A, Blank, L, Payne N, et al. Demand management: misguided solutions? Br J Gen Pract 2013; DOI: 10.3399/bjgp13X670859.
4. Akbari A, Mayhew A, Al-Alawi MA, et al. Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database Syst Rev 2008; (4): CD005471.
5. Imison C, Naylor C. Referral management: lessons for success. London: The King's Fund, 2010. http://www.kingsfund.org.uk/sites/files/kf/Referralmanagement-lessons-for-success-Candace-Imison-Chris-Naylor-Kings-Fund-August2010.pdf (accessed 15 Oct 2014).
6. Evidence for Policy and Practice Information and Co-ordinating Centre. EPPICentre methods for conducting systematic reviews. Updated 2010. http://eppi.ioe.ac.uk/cms/LinkClick.aspx?fileticket=hQBu8y4uVwI%3D&tabid=88 (accessed 15 Oct 2014).
7. Grant MJ, Brettle A, Long AF. Developing a review question: a spiral approach to literature searching. Poster presentation. 3rd Symposium on Systematic Reviews: Beyond the basics. Improving quality and impact, Oxford, 3-5 July 2000.
8. Higgins JPT, Altman DG. Assessing risk of bias in included studies. In Higgins JPT, Green S, eds. Cochrane handbook for systematic reviews of interventions. Version 5.0.1. The Cochrane Collaboration, 2008. http://hiv.cochrane.org/sites/hiv.cochrane.org/files/uploads/Ch08-Bias.pdf (accessed 29 Oct 2014).
9. Hoogendoorn WE, van Poppel MN, Bongers PM, et al. Physical load during work and leisure time as risk factors for back pain. Scand J Work Environ Health 1999; 25 (5): 387-403.
10. Cooper R. How peer review reduced GP referrals by 25% in two months. Pulse 2012; 72 (10): 31.
11. Evans E. The Torfaen referral evaluation project. Qual Prim Care 2009; 17 (6): 423-429.
12. Evans E, Aiking H, Edwards A. Reducing variation in general practitioner referral rates through clinical engagement and peer review of referrals: a service improvement project. Qual Prim Care 2011; 19 (4): 263-272.
13. Jiwa M, Walters S, Mathers N. Referral letters to colorectal surgeons: the impact of peer-mediated feedback. Br J Gen Pract 2004; 54 (499): 123-126.
14. Ramsay CR, Eccles M, Grimshaw JM, Steen N. Assessing the long-term effect of educational reminder messages on primary care radiology referrals. Clin Radiol 2003; 58 (4): 319-321.
15. Shariff Z, Roshan A, Williams AM, Platt AJ. 2-Week wait referrals in suspected skin cancer: does an instructional module for general practitioners improve diagnostic accuracy? Surgeon 2010; 8 (5): 247-251.
16. Kousgaard KR, Nielsen JD, Olesen F, Jensen AB. General practitioner assessment of structured oncological information accompanying newly referred cancer patients. Scand J Prim Health Care 2003; 21 (2): 110-114.
17. Bennett K, Haggard M, Churchill R, Wood S. Improving referrals for glue ear from primary care: are multiple interventions better than one alone? J Health Serv Res Policy 2001; 6 (3): 139-144.
18. Donohoe ME, Fletton JA, Hook A, et al. Improving foot care for people with diabetes mellitus: a randomized controlled trial of an integrated care approach. Diabet Med 2000; 17 (8): 581-587.
19. Watson E, Clements A, Yudkin P, et al. Evaluation of the impact of two educational interventions on GP management of familial breast/ovarian cancer cases: a cluster randomised controlled trial. Br J Gen Pract 2001; 51 (471): 817-821.
20. Adams SG, Pitts J, Wynne J, et al. Effect of a primary care continuing education program on clinical practice of chronic obstructive pulmonary disease: translating theory into practice. Mayo Clin Proc 2012; 87 (9): 862-870.
21. Bhalla RK, Unwin D, Jones TM, Lesser T. Does clinical assistant experience in ENT influence general practitioner referral rates to hospital? J Laryngol Otol 2002; 116 (8): 586-588.
22. Ellard R, Gulati A, Hubbard V, et al. The impact of physician education on primary care referrals in dermatology [abstract]. Br J Dermatol 2012; 167 (Suppl 1): P41.
23. Emmerson WB, Frost A, Powell JL, et al. Evaluating a GP consultative psychiatric service in an Australian metropolitan hospital district. Australas Psychiatry 2003; 11 (2): 195-198.
24. Hands S, Holbrook J. Are one-to-one outpatient teaching sessions a useful way for GPs to undertake their continuing education? Educ Prim Care 2001; 12 (4): 392-400.
25. Hilty DM, Yellowlees PM, Nesbitt TS. Evolution of telepsychiatry to rural sites: changes over time in types of referral and in primary care providers' knowledge, skills and satisfaction. Gen Hosp Psychiatry 2006; 28 (5): 367-373.
26. Lam TP, Chow RW, Lam KF, et al. Evaluation of the learning outcomes of a year-long postgraduate training course in community geriatrics for primary care doctors. Arch Gerontol Geriatr 2011; 52 (3): 350-356.
27. Lester H, Birchwood M, Freemantle N, et al. REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis. Br J Gen Pract 2009 DOI: 10.3399/bjgp09X420851.
28. Rowlands G, Sims J, Kerry S, et al. Within-practice educational meetings and GP referrals to secondary care: an aid to reflection and review of clinical practice. Educ Prim Care 2003; 14 (4): 449-462.
29. Suris X, Cerdà D, Ortiz-Santamaría V, et al. A rheumatology consultancy program with general practitioners in Catalonia, Spain. J Rheumatol 2007; 34 (6): 1328-1331.
30. Wolters R, Wensing M, Klomp M, et al. Effects of distance learning on clinical management of LUTS in primary care: a randomised trial. Patient Educ Couns 2005; 59 (2): 212-218.
31. Malik A, Wigney L, Murray S, Gerrand CH. The effectiveness of 'two-week' referrals for suspected bone and soft tissue sarcoma. Sarcoma 2007; DOI: 10.1155/2007/23870.
32. Twomey P. Making the best use of a radiology department: an example of implementation of a referral guideline within a primary care organisation. Qual Prim Care 2003; 11 (1): 53-59.
33. Cusack CM, Buckley CC. Efficacy of issuing guidelines on acne management to general practitioners. Br J Dermatol 2005; 152 (6): 1392-1393.
34. Idiculla JM, Perros P, Frier BM. Do diabetes guidelines influence the content of referral letters by general practitioners to a diabetes specialist clinic? Health Bull (Edinb) 2000; 58 (4): 322-327.
35. Lucassen A, Watson E, Harcourt J, et al. Guidelines for referral to a regional genetics service: GPs respond by referring more appropriate cases. Fam Pract 2001; 18 (2): 135-140.
36. Potter S, Govindarajulu S, Shere M, et al. Referral patterns, cancer diagnoses, and waiting times after introduction of two week wait rule for breast cancer: prospective cohort study. BMJ 2007; 335 (7614): 288-290.
37. Imkampe A, Bendall S, Chianakwalam C. Two-week rule: has prioritisation of breast referrals by general practitioners improved? Breast 2006; 15 (5): 654-658.
38. Fearn S, Larner AJ. Have Quality and Outcomes Framework Depression Indicators changed referrals from primary care to a dedicated memory clinic? Ment Health Fam Med 2009; 6 (3): 129-132.
39. Hill VA, Wong E, Hart CJ. General practitioner referral guidelines for dermatology: do they improve the quality of referrals? Clin Exp Dermatol 2000; 25 (5): 371-376.
40. Matowe L, Ramsay CR, Grimshaw JM, et al. Effects of mailed dissemination of the Royal College of Radiologists' guidelines on general practitioner referrals for radiography: a time series analysis. Clin Radiol 2002; 57 (7): 575-578.
41. Melia J, Coulson P, Coleman D, Moss S. Urological referral of asymptomatic men in general practice in England. Br J Cancer 2008; 98 (7): 1176-1181.
42. West YR, Kendrick BJ, Williamson DM. Evaluation of the impact of orthopaedic guidelines on referrals from primary care to a specialist department. Qual Prim Care 2007; 15 (1): 27-31.
43. Banait G, Sibbald B, Thompson D, et al. Modifying dyspepsia management in primary care: a cluster randomised controlled trial of educational outreach compared with passive guideline dissemination. Br J Gen Pract 2003; 53 (487): 94-100.
44. Eccles M, Steen N, Grimshaw J, et al. Effect of audit and feedback, and reminder messages on primary-care radiology referrals: a randomised trial. Lancet 2001; 357 (9266): 1406-1409.
45. Elwyn G, Owen D, Roberts L, et al. Influencing referral practice using feedback of adherence to NICE guidelines: a quality improvement report for dyspepsia. Qual Saf Health Care 2007; 16 (1): 67-70.
46. Wright J, Harrison S, McGeorge M, et al. Improving the management and referral of patients with transient ischaemic attacks: a change strategy for a health community. Qual Saf Health Care 2006; 15 (1): 9-12.
47. Glaves J. The use of radiological guidelines to achieve a sustained reduction in the number of radiographic examinations of the cervical spine, lumbar spine and knees performed for GPs. Clin Radiol 2005; 60 (8): 914-920.
48. Griffiths CE, Taylor H, Collins SI, et al. The impact of psoriasis guidelines on appropriateness of referral from primary to secondary care: a randomized controlled trial. Br J Dermatol 2006; 155 (2): 393-400.
49. Kerry S, Oakeshott P, Dundas D, Williams J. Influence of postal distribution of the Royal College of Radiologists' guidelines, together with feedback on radiological referral rates, on X-ray referrals from general practice: a randomized controlled trial. Fam Pract 2000; 17 (1): 46-52.
50. Robling MR, Houston HL, Kinnersley P, et al. General practitioners' use of magnetic resonance imaging: an open randomized trial comparing telephone and written requests and an open randomized controlled trial of different methods of local guideline dissemination. Clin Radiol 2002; 57 (5): 402-407.
51. White T, Marriott S. Using evidence-based dissemination and implementation strategies to improve routine communication between general practitioners and community mental health teams. Psychiatr Bull 2004; 28: 8-11.
52. Julian S, Naftalin NJ, Clark M, et al. An integrated care pathway for menorrhagia across the primary-secondary interface: patients' experience, clinical outcomes, and service utilisation. Qual Saf Health Care 2007; 16 (2): 110-115.
53. Walkowski K, Peel C, Sandy L. Effect of academic detailing on primary care referral patterns to high performing cardiac specialists. J Gen Intern Med 2007; 22 (1 Suppl): 196-197.
54. Morrison J, Carroll L, Twaddle S, et al. Pragmatic randomised controlled trial to evaluate guidelines for the management of infertility across the primary caresecondary care interface. BMJ 2001; 322 (7297): 1282-1284.
55. Wilson BJ, Torrance N, Mollison J, et al. Cluster randomized trial of a multifaceted primary care decision-support intervention for inherited breast cancer risk. Fam Pract 2006; 23 (5): 537-544.
56. Dey P, Simpson CW, Collins SI, et al. Implementation of RCGP guidelines for acute low back pain: a cluster randomised controlled trial. Br J Gen Pract 2004; 54 (498): 33-37.
57. Engers AJ, Wensing M, van Tulder MW, et al. Implementation of the Dutch low back pain guideline for general practitioners: a cluster randomized controlled trial. Spine 2005; 30 (6): 559-600.
58. Jiwa M, Skinner P, Coker AO, et al. Implementing referral guidelines: lessons from a negative outcome cluster randomised factorial trial in general practice. BMC Fam Pract 2006; 7: 65.
59. Spatafora S, Canepa G, Migliari R, et al. Effects of a shared protocol between urologists and general practitioners on referral patterns and initial diagnostic management of men with lower urinary tract symptoms in Italy: the Prostate Destination study. BJU Int 2005; 95 (4): 563-570.
60. Bridgman S, Li X, Mackenzie G, Dawes P. Does the North Staffordshire slot system control demand of orthopaedic referrals from primary care? A population-based survey in general practice. Br J Gen Pract 2005; 55 (518): 704-709.
61. Khan A, Smith DA, Whittaker J, et al. Abstract S26: effectiveness of direct GP referrals to hospital specialist respiratory teams in avoiding acute admissions. Thorax 2008; 63 (Suppl 7): A12-A15.
62. Sved-Williams A, Poulton J. Primary care mental health consultation-liaison: a connecting system for private psychiatrists and general practitioners. Australas Psychiatry 2010; 18 (2): 125-129.
63. Hemingway DM, Jameson J, Kelly MJ; Leicester Colorectal Specialist Interest Group Project Steering Committee. Straight to test: introduction of a city-wide protocol driven investigation of suspected colorectal cancer. Colorectal Dis 2006; 8 (4): 289-295.
64. McNally OM, Wareham V, Flemming DJ, et al. The impact of the introduction of a fast track clinic on ovarian cancer referral patterns. Eur J Cancer Care (Engl) 2003; 12 (4): 327-330.
65. Prades J, Espinàs JA, Font R, et al. Implementing a Cancer Fast-track Programme between primary and specialised care in Catalonia (Spain): a mixed methods study. Br J Cancer 2011; 105 (6): 753-759.
66. DAMASK (Direct Access to Magnetic Resonance Imaging: Assessment for Suspect Knees) Trial Team. Cost-effectiveness of magnetic resonance imaging of the knee for patients presenting in primary care. Br J Gen Pract 2008; DOI: 10.3399/bjgp08X342660.
67. Shaw IS, Valori RM, Charlett A, McNulty CA. Limited impact on endoscopy demand from a primary care based 'test and treat' dyspepsia management strategy: the results of a randomised controlled trial. Br J Gen Pract 2006; 56 (526): 369-374.
68. Simpson GC, Forbes K, Teasdale E, et al. Impact of GP direct-access computerised tomography for the investigation of chronic daily headache. Br J Gen Pract 2010; 60 (581): 897-901.
69. Thomas RE, Grimshaw JM, Mollison J, et al. Cluster randomized trial of a guideline-based open access urological investigation service. Fam Pract 2003; 20 (6): 646-654.
70. Thomas R, Cook A, Main G, et al. Primary care access to computed tomography for chronic headache. Br J Gen Pract 2010; 60 (575): 426-430.
71. Wong BC, Chan CK, Wong KW, et al. Evaluation of a new referral system for the management of dyspepsia in Hong Kong: role of open-access upper endoscopy. J Gastroenterol Hepatol 2000; 15 (11): 1251-1256.
72. Dhillon V, Creiger J, Hannan J, et al. The effect of DXA scanning on clinical decision making by general practitioners: a randomized, prospective trial of direct access versus referral to a hospital consultant. Osteoporos Int 2003; 14 (4): 326-333.
73. Eley KA, Fitzgerald JE. Quality improvement in action. Direct general practitioner referrals to audiology for the provision of hearing aids: a single centre review. Qual Prim Care 2010; 18 (3): 201-206.
74. Gough-Palmer AL, Burnett C, Gedroyc WM. Open access to MRI for general practitioners: 12 years' experience at one institution - a retrospective analysis. Br J Radiol 2009; 82 (980): 687-690.
75. Leggett P, Gilliland AE, Cupples ME, et al. A randomized controlled trial using instant photography to diagnose and manage dermatology referrals. Fam Pract 2004; 21 (1): 54-56.
76. Eminovic N, de Keizer NF, Wyatt JC, et al. Teledermatologic consultation and reduction in referrals to dermatologists: a cluster randomized controlled trial. Arch Dermatol 2009; 145 (5): 558-564.
77. Whited JD, Hall RP, Foy ME, et al. Teledermatology's impact on time to intervention among referrals to a dermatology consult service. Telemed J E Health 2002; 8 (3): 313-321.
78. McKoy KC, DiGregorio S, Stira L. Asynchronous teledermatology in an urban primary care practice. Telemed J E Health 2004; 10 (Suppl 2): S70-S80.
79. Knol A, van den Akker TW, Damstra RJ, de Haan J. Teledermatology reduces the number of patient referrals to a dermatologist. J Telemed Telecare 2006; 12 (2): 75-78.
80. Hockey AD, Wootton R, Casey T. Trial of low-cost teledermatology in primary care. J Telemed Telecare 2004; 10 (Suppl 1): 44-47.
81. Nielsen JD, Palshof T, Mainz J, et al. Randomised controlled trial of a shared care programme for newly referred cancer patients: bridging the gap between general practice and hospital. Qual Saf Health Care 2003; 12 (4): 263-272.
82. Harrington JT, Dopf CA, Chalgren CS. Implementing guidelines for interdisciplinary care of low back pain: a critical role for pre-appointment management of specialty referrals. Jt Comm J Qual Improv 2001; 27 (12): 651-663.
83. Wallace P, Barber J, Clayton W, et al. Virtual outreach: a randomised controlled trial and economic evaluation of joint teleconferenced medical consultations. Health Technol Assess 2004; 8 (50): 1-106.
84. Jaatinen PT, Aarnio P, Remes J, et al. Teleconsultation as a replacement for referral to an outpatient clinic. J Telemed Telecare 2002; 8 (2): 102-106.
85. Tadros A, Murdoch R, Stevenson JH. Digital image referral for suspected skin malignancy: a pilot study of 300 patients. J Plast Reconstr Aesthet Surg 2009; 62 (8): 1048-1053.
86. Nicholson C, Jackson CL, Wright B, et al. Online referral and OPD booking from the GP desktop. Aust Health Rev 2006; 30 (3): 397-404.
87. Kim Y, Chen AH, Keith E, et al. Not perfect, but better: primary care providers' experiences with electronic referrals in a safety net health system. J Gen Intern Med 2009; 24 (5): 614-619.
88. Dennison J, Eisen S, Towers M, Ingham Clark C. An effective electronic surgical referral system. Ann R Coll Surg Engl 2006; 88 (6): 554-556.
89. Chen AH, Kushel MB, Grumbach K, Yee HF Jr. A safety-net system gains efficiencies through 'eReferrals' to specialists. Health Aff 2010; 29 (5): 969-971.
90. Gandhi TK, Sittig DF, Franklin M, et al. Communication breakdown in the outpatient referral process. J Gen Intern Med 2000; 15 (9): 626-631.
91. Kim-Hwang JE, Chen AH, Bell DS, et al. Evaluating electronic referrals for specialty care at a public hospital. J Gen Intern Med 2010; 25 (10): 1123-1128.
92. Stoves J, Connolly J, Cheung CK, et al. Electronic consultation as an alternative to hospital referral for patients with chronic kidney disease: a novel application for networked electronic health records to improve the accessibility and efficiency of healthcare. Qual Saf Health Care 2010; DOI: 10.1136/qshc.2009.038984.
93. Patterson V, Humphreys J, Chua R. Email triage of new neurological outpatient referrals from general practice. J Neurol Neurosurg Psychiatry 2004; 75 (4): 617-620.
94. Jiwa M, Dhaliwal S. Referral Writer: preliminary evidence for the value of comprehensive referral letters. Qual Prim Care 2012; 20 (1): 39-45.
95. Kennedy AM, Aziz A, Khalid S, Hurman D. Do GP referral guidelines really work? Audit of an electronic urgent referral system for suspected head and neck cancer. Eur Arch Otorhinolaryngol 2012; 269 (5): 1509-1512.
96. McGowan J, Hogg W, Campbell C, Rowan M. Just-in-time information improved decision-making in primary care: a randomized controlled trial. PloS ONE 2008; 3 (11): e3785. doi: 10.1371/journal.pone.0003785.
97. Junghans C, Feder G, Timmis AD, et al. Effect of patient-specific ratings vs conventional guidelines on investigation decisions in angina: Appropriateness of Referral and Investigation in Angina (ARIA) Trial. Arch Intern Med 2007; 167 (2): 195-202.
98. Akbari A, Grimshaw J, Stacey D, et al. Change in appropriate referrals to nephrologists after the introduction of automatic reporting of the estimated glomerular filtration rate. CMAJ 2012; 184 (5): E269-E276. doi: 10.1503/cmaj.110678.
99. Emery J, Morris H, Goodchild R, et al. The GRAIDS Trial: a cluster randomised controlled trial of computer decision support for the management of familial cancer risk in primary care. Br J Cancer 2007; 97 (4): 486-493.
100. Knab JH, Wallace MS, Wagner RL, et al. The use of a computer-based decision support system facilitates primary care physicians' management of chronic pain. Anesth Analg 2001; 93 (3): 712-720.
101. Mariotti G, Meggio A, de Pretis G, Gentilini M. Improving the appropriateness of referrals and waiting times for endoscopic procedures. J Health Serv Res Policy 2008; 13 (3): 146-151.
102. Greiver M, Drummond N, White D, et al. Angina on the Palm: randomized controlled pilot trial of Palm PDA software for referrals for cardiac testing. Can Fam Physician 2005; 51: 382-383.
103. Magill MK, Day J, Mervis A, et al. Improving colonoscopy referral rates through computer-supported, primary care practice redesign. J Healthc Qual 2009; 31 (4): 43-52.
104. Tierney WM, Overhage JM, Murray MD, et al. Effects of computerized guidelines for managing heart disease in primary care. J Gen Intern Med 2003; 18 (12): 967-976.
105. Slade M, Gask L, Leese M, et al. Failure to improve appropriateness of referrals to adult community mental health services: lessons from a multi-site cluster randomized controlled trial. Fam Pract 2008; 25 (3): 181-190.
106. Stainkey LA, Seidl IA, Johnson AJ, et al. The challenge of long waiting lists: how we implemented a GP referral system for non-urgent specialist appointments at an Australian public hospital. BMC Health Serv Res 2010; 10: 303.
107. King RHB, Bateman H. Piloting an approach to the identification of avoidable referrals in a general practice with a high referral rate. Journal of Clinical Excellence 2001; 2 (4): 209-213.
108. van Bokhoven MA, Koch H, van der Weijden T, et al. The effect of watchful waiting compared to immediate test ordering instructions on general practitioners' blood test ordering behaviour for patients with unexplained complaints; a randomized clinical trial (ISRCTN55755886). Implement Sci 2012; 7: 29.
109. Callaway P, Frisch L. Does a family physician who offers colposcopy and LEEP need to refer patients to a gynecologist? J Fam Pract 2000; 49 (6): 534-536.
110. Standing P, Dent M, Craig A, Glenville B. Changes in referral patterns to cardiac outpatient clinics with ambulatory ECG monitoring in general practice. Br J Cardiol 2001; 8 (6): 394-398.
111. van Dijk CE, Verheij RA, Spreeuwenberg P, et al. Minor surgery in general practice and effects on referrals to hospital care: observational study. BMC Health Serv Res 2011; 11: 2.
112. Ridsdale L, Doherty J, McCrone P, et al. A new GP with special interest headache service: observational study. Br J Gen Pract 2008; 58 (552): 478-483.
113. Salisbury C, Noble A, Horrocks S, et al. Evaluation of a general practitioner with special interest service for dermatology: randomised controlled trial. BMJ 2005; 331 (7530): 1441-1446.
114. Sanderson D. Evaluation of the GPs with special interests (GPwSIs) pilot projects within the Action On ENT Programme: final report. York: Department of Health Modernisation Agency. York Health Economics Consortium. 2002.
115. Sauro A, Scalzitti F, Buono N, et al. Spirometry is really useful and feasible in the GP's daily practice but guidelines alone are not. Eur J Gen Pract 2005; 11 (1): 29-31.
116. Rosen R, Jones R, Tomlin Z, Cavanagh MR. Evaluation of general practitioners with special interests: access, cost evaluation and satisfaction with services. National Institute for Health Research, 2006. http://www.nets.nihr.ac.uk/-data/assets/pdf-file/0005/64445/FR-08-1210-035.pdf (accessed 15 Oct 2014).
117. Levell NJ, Penart-Lanau AM, Garioch JJ. Introduction of intermediate care dermatology services in Norfolk, England was followed by a 67% increase in referrals to the local secondary care dermatology department. Br J Dermatol 2012; 167 (2): 443-445.
118. Leiba AM, Martonovits G, Magnezi R, et al. Evaluation of a specialist outreach clinic in a primary healthcare setting: the effect of easy access to specialists. Clinician in Management 2002; 11 (3): 131-136.
119. Campbell H, Holloway S, Cetnarskyj R, et al. Referrals of women with a family history of breast cancer from primary care to cancer genetics services in South East Scotland. Br J Cancer 2003; 89 (9): 1650-1656.
120. Felker BL, Barnes RF, Greenberg DM, et al. Preliminary outcomes from an integrated mental health primary care team. Psychiatr Serv 2004; 55 (4): 442-444.
121. Gurden M, Morelli M, Sharp G, et al. Evaluation of a general practitioner referral service for manual treatment of back and neck pain. Prim Health Care Res Dev 2012; 13 (3): 204-210.
122. Schulpen GJ, Vierhout WP, van der Heijde DM, et al. Joint consultation of general practitioner and rheumatologist: does it matter? Ann Rheum Dis 2003; 62 (2): 159-161.
123. Vlek JF, Vierhout WP, Knottnerus JA, et al. A randomised controlled trial of joint consultations with general practitioners and cardiologists in primary care. Br J Gen Pract 2003; 53 (487): 108-112.
124. Hughes-Anderson W, Rankin SL, House J, et al. Open access endoscopy in rural and remote Western Australia: does it work? ANZ J Surg 2002; 72 (10): 699-703.
125. Hermush V, Daliot D, Weiss A, et al. The impact of geriatric consultation on the care of the elders in community clinics. Arch Gerontol Geriatr 2009; 49 (2): 260-262.
126. Pfeiffer PN, Szymanski BR, Zivin K, et al. Are primary care mental health services associated with differences in specialty mental health clinic use? Psychiatr Serv 2011; 62 (4): 422-425.
127. Johnson G, White A, Livingstone R. Do general practices which provide an acupuncture service have low referral rates and prescription costs? A pilot survey. Acupunct Med 2008; 26 (4): 205-213.
128. Wylie KR, Davies-South D. Returning a referral for erectile dysfunction to the referrer by two different routes. BJU Int 2001; 87 (9): 846-848.
129. Tan E, Levell NJ, Garioch JJ. The effect of a dermatology restricted-referral list upon the volume of referrals. Clin Exp Dermatol 2007; 32 (1): 114-115.
130. van Dijk CE, Verheij RA, Hansen J, et al. Primary care nurses: effects on secondary care referrals for diabetes. BMC Health Serv Res 2010; 10: 230.
131. White M, Bijlani N, Bale R, Burns T. Impact of counsellors in primary care on referrals to secondary mental health services. Psychiatr Bull 2000; 24 (11): 418-420.
132. Simpson S, Corney R, Fitzgerald P. Counselling provision, prescribing and referral rates in a general practice setting. Primary Care Psychiatry 2003; 8 (4): 115-119.
133. Schillinger D, Bibbins-Domingo K, Vranizan K, et al. Effects of primary care coordination on public hospital patients. J Gen Intern Med 2000; 15 (5): 329-336.
134. Ferris TG, Chang Y, Blumenthal D, Pearson SD. Leaving gatekeeping behind: effects of opening access to specialists for adults in a health maintenance organization. N Engl J Med 2001; 345 (18): 1312-1317.
135. Ferris TG, Chang Y, Perrin JM, et al. Effects of removing gatekeeping on specialist utilization by children in a health maintenance organization. Arch Pediatr Adolesc Med 2002; 156 (6): 574-579.
136. Joyce GF, Kapur K, Van Vorst KA, Escarce JJ. Visits to primary care physicians and to specialists under gatekeeper and point-of-service arrangements. Am J Manag Care 2000; 6 (11): 1189-1196.
137. McGarry H, Hegarty K, Johnson C, et al. Managing depression in a changing primary mental healthcare system: comparison of two snapshots of Australian GPs' treatment and referral patterns. Ment Health Fam Med 2009; 6 (2): 75-83.
138. van Dijk CE, Verheij RA, Spreeuwenberg P, et al. Impact of remuneration on guideline adherence: empirical evidence in general practice. Scand J Prim Health Care 2013; 31 (1): 56-63.
139. Vardy DA, Freud T, Sherf M, et al. A co-payment for consultant services: primary care physicians' referral actualization. J Med Syst 2008; 32 (1): 37-41.
140. Iversen T, Luras H. The effect of capitation on GPs' referral decisions. Health Econ 2000; 9 (3): 199-210.
141. Watson E, Clements A, Lucassen A, et al. Education improves general practitioner (GP) management of familial breast/ovarian cancer: findings from a cluster randomised controlled trial. J Med Genet 2002; 39 (10): 779-781.
142. Whiting M. Introducing a GP-led referral gateway. Pulse 2011; 71 (18): 29-30.
143. Maddison P, Jones J, Breslin A, et al. Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) programme. BMJ 2004; 329 (7478): 1325-1327.
144. Kim C, Williamson DF, Herman WH, et al. Referral management and the care of patients with diabetes: the Translating Research Into Action for Diabetes (TRIAD) study. Am J Manag Care 2004; 10 (2): 137-143.
145. Cox JM, Steel N, Clark AB, et al. Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management. Br J Gen Pract 2013; DOI: 10.3399/bjgp13X668177.
146. Ferriter K, Gangopadhyay P, Nilforooshan R, et al. Quality of referrals to old age psychiatry following introduction of the single assessment process. Psychiatr Bull 2006; 30 (12): 452-453.
147. Albertson G, Lin CT, Schilling L, et al. Impact of a simple intervention to increase primary care provider recognition of patient referral concerns. Am J Manag Care 2002; 8 (4): 375-381.
148. Heaney D, Wyke S, Wilson P, et al. Assessment of impact of information booklets on use of healthcare services: randomised controlled trial. BMJ 2001; 322 (7296): 1218-1221.
149. Lyon D, Knowles J, Slater B, Kennedy R. Improving the early presentation of cancer symptoms in disadvantaged communities: putting local people in control. Br J Cancer 2009; 101 (Suppl 2): S49-S54.
150. Patton MQ. Qualitative research and evaluation methods. 3rd edn. Thousand Oaks, CA: Sage Publications, 2002.
151. Baxter SK, Blank L, Woods HB, et al. Using logic model methods in systematic review synthesis: describing complex pathways in referral management interventions. BMC Med Res Methodol 2014; 14: 62.