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Published on: August 1, 2019
Implementing referral guidelines: lessons from a negative outcome cluster randomised factorial trial in general
Moyez Jiwa1, Paul Skinner, Akinoso Olujimi Coker
1Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia. moyez.jiwa@curtin.edu.au
BMC Family Practice
|November 3, 2006
Summary
This study found that neither electronic referral proformas nor surgeon outreach visits significantly increased the detection of significant pathology in patients referred for lower bowel symptoms. Referral letter quality improved with electronic proformas.
Area of Science:
- Gastroenterology
- General Practice
- Health Services Research
Background:
- Most patients with lower bowel symptoms do not require specialist referral.
- However, referred patients may benefit from more thorough pre-referral assessment.
- This study investigated interventions to improve the referral process for lower bowel symptoms.
Purpose of the Study:
- To evaluate the effectiveness of an electronic interactive referral proforma and educational outreach visits by colorectal surgeons in improving patient assessment and detection of significant pathology.
- To assess the impact of these interventions on the quality of referral letters.
Main Methods:
- A cluster randomized factorial trial involving 44 general practices in the UK.
- Practices were assigned to receive an electronic referral proforma, educational outreach, both, or neither.
- Outcomes included the proportion of referred patients with significant pathology and referral letter quality.
Main Results:
- No significant difference in the proportion of patients with significant pathology was found between intervention and control groups.
- The electronic proforma group showed a trend towards lower detection rates (14% vs 19%).
- Referral letter quality was improved in practices using the electronic proforma.
Conclusions:
- Neither intervention demonstrated a significant increase in the detection of organic pathology among referred patients.
- Electronic software improved referral letter information but its clinical impact was unconfirmed.
- Limited uptake of interventions may have reduced their potential impact.
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