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Purpose: The study was aimed at finding out the present pattern of referrals to the Pediatric Ophthalmology outpatient department (OPD) in a tertiary eye care hospital and thus identify the discrepancy of referral, if any, which would help to modify and enhance the practice guidelines. Methods: The study was conducted by retrospectively collecting data from all referral letters that were already uploaded in the Electronic Medical Report (EMR) against all patients from June 2019 to December 2019. All pediatric patients in the age group of 0–16 years were included in the study. The practicing field of referring clinicians was noted along with the maximum information that could be collected from the referral letter and were thus assessed for the quality, accuracy, and timely referral. Results: Out of 77 referrals received in the study period, six referral letters neither had any mention of the designation of the referring clinician nor any specific diagnosis or details. Thus, only 71 patients were included for further study. The referring clinicians were mainly ophthalmologists, pediatricians, general practitioners (GPs), and others (cardiologists, neurologists). Maximum patients were referred by ophthalmologists (76%) but visual acuity was noted only for 30% of these patients. Almost half of the referral diagnosis was accurate. Pediatrician referrals were found to be more detailed and précised. Conclusion: There is a need for a standardized hospital?specific format of referrals and basic training to primary care providers on some simple tests (Lights reflex tests) for identifying the “red flags” in pediatric eye examination and thus enhancing the quality and timely referral per se
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Objectives: To evaluate the type of "periodontal treatment" performed by general dental practitioners and the referral patterns of periodontists in Iraq. Material and methods: A total of 201 general dentists were asked to complete a self-administered questionnaire consisting of nine questions regarding periodontal treatment and the referral patterns of periodontists. Results: The study showed that 91.1% of general dental practitioners (GDPs) performed "phase-I therapy", and most of them done "scaling". Regarding surgical periodontal therapy, only 12.9% of them performed surgical periodontal therapy, half of the GDPs did gingivectomy, and less than 30% performed crown lengthening. When evaluating maintenance therapy after periodontal treatment, it was found that 77.9% of the GDPs scheduled appointments for patients in the maintenance phase, 49.4% of them after one month, 24.7% after three months, and 15.6% after six months. Using TRUF analysis, most general dentists believed that the patient and periodontal factors were responsible for the recurrence of periodontal disease. Conclusions: There is still a lack of awareness of periodontal surgical procedures among the "general dental practitioners". Thus, it is essential to increase the comprehension of periodontal treatment among general dentists. (AU)
Objetivo: Avaliar o tipo de "tratamento periodontal" realizado por dentistas generalistas e os padrões de encaminhamento aos periodontistas, no Iraque. Material e métodos: Um total de 201 dentistas generalistas preencheram um questionário autoaplicável que consistiu em nove perguntas sobre o tratamento periodontal e os padrões de encaminhamento para periodontistas. Resultados: O estudo mostrou que 91,1% dos dentistas gerais (DG) realizavam "terapia fase I" e a maioria realizava "raspagem". Em relação à terapia periodontal cirúrgica, apenas 12,9% deles realizavam, sendo que metade dos DG realizavam gengivectomia e menos de 30% realizavam aumento de coroa clínica. Ao avaliar a terapia de manutenção após o tratamento periodontal, constatou-se que 77,9% dos DGs agendaram consultas para pacientes em fase de manutenção, sendo 49,4% após um mês, 24,7% após três meses e 15,6% após seis meses. Usando a análise TRUF, a maioria dos dentistas gerais acredita que o paciente e os fatores periodontais são responsáveis pela recorrência da doença periodontal. Conclusões: Ainda existe um desconhecimento dos procedimentos cirúrgicos periodontais entre os "dentistas generalistas". Assim, é essencial aumentar a compreensão do tratamento periodontal entre os cirurgiões-dentistas gerais (AU)
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Humans , Periodontics , Dental Scaling , Dentists , GingivectomyABSTRACT
Background: Maternal morbidity and mortality remains a major challenge. At present pregnant women can visit any level of health care irrespective of severity of their health condition. Most of the burden of these pregnant women is on tertiary centers, hence depriving the seriously ill of the expert care. Most of the pregnancies can be managed at primary level itself. This study was therefore conducted in order to describe the referral pattern of pregnant women coming to Cheluvamba Hospital, Mysuru.Methods: It was a cross sectional study conducted during September 2018 with sample size of 100. All the pregnant women who were referred in the second week of September 2018 were included in the study without using any sampling technique and data was collected by interview using the semistructured questionnaire.Results: Mean distance travelled by study participants from their residence to Cheluvamba hospital was 42.1±29.8 kilometers. Main obstetric and logistic reason for referral was because of hypertensive disorders and non-availability of doctors respectively. Average number of ANC visits and mean gestational age upon arrival at Cheluvamba hospital was 6.71±2.3 visits and 37.4±3.6 weeks respectively.Conclusions: Most common obstetric reason for referral was hypertensive disorders. A structured referral system would help both the patient and the doctor in providing necessary obstetric care.
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Background: In the act of medical practice, referral is the transfer of a patient’s care from one physician or clinician to another. Appropriate referral is an integral part of a complete quality health care management. At present, patients can visit any level of health care irrespective of severity of their health condition and most of the burden of these patients is on tertiary centers. This study was done to describe the Referral Pattern of Patients Coming to Mandya Institute of Medical Sciences, Mandya.Methods: It was a cross sectional study conducted from October 2017 to November 2017 with sample size of 400, p=50%. Sampling technique used was convenient sampling and data was collected by interview using the semistructured questionnaire.Results: Among the study population 197 (49.3%) were males and 203 (50.7%) were females, 392 (82.3%) had BPL card. Mean distance travelled by them to MIMS was 17.7±14.8 km. Medicine department n=80 (20%) followed by ophthalmology department n=64 (16%) were the most frequently visited departments. Mean distance to the nearest health center from their place of residence was 3.2%±2.9 km. 148 (37.0%) visited the health center near their place of residence before coming to MIMS and 253 (63.0%) did not visit.Conclusions: Most of the patients visited tertiary healthcare center (MIMS) without visiting health center near to them, though the distance is more and availability of specialists and low cost of treatment were the main reasons for visiting MIMS.
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Background: General dentistry care is of paramount importance in maintaining oral hygiene of cancer patients. Methods: The data of patients registered at the dental wing in a tertiary care cancer center for one year period (2013) was used for the present analysis. All the cases were retrospectively analyzed for the pattern of referral, diagnosis of different oro-dental conditions, and different interventions done for the various oro-dental conditions. Results: A total of 798 patients were referred from various oncology wings for management of oro-dental problems, 50.1% patients were referred from head and neck oncology, 31% were from radiation department, 6.2% patients were from medical oncology and palliative care department each, 4% patients were from gynecologic oncology, and 2.5% patients were from screening wing. Acute gingivitis (62%) in pre treatment and mucositis (28%) in post treatment were major symptoms and signs for referral. 47% patients were managed with tooth extraction, grinding was done on 23%, scaling were done on 12.5%, desensitization was done on 8.7% patients, filling was done on 2.5% patients, prosthesis fitting in 2.5% patients, root canal treatment in 2.2% patients, and post surgical obturator fittings in 0.75% patients. Conclusion: Majority of cancer patients were referred for oro-dental care from head and neck oncology department with head and neck cancers and extraction of tooth pre radiotherapy and chemotherapy remains an important part of oro-dental care in cancer patients.
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Primary care providers play an important gatekeeping role in ensuring appropriate referrals to secondary care facilities. This cross-sectional study aimed to determine the level, pattern and rate of referrals from health clinics to hospitals in the public sector, and whether the placement of resident family medicine specialist (FMS) had made a significant difference. The study was carried out between March and April in 2012, involving 28 public primary care clinics. It showed that the average referral rate was 1.56% for clinics with resident FMS and 1.94% for those without resident FMS, but it was not statistically significant. Majority of referred cases were considered appropriate (96.1%). Results of the multivariate analysis showed that no prior consultation with senior healthcare provider and illnesses that were not severe and complex were independently associated with inappropriate referrals. Severity, complexity or uncertain diagnosis of patients’ illness or injury significantly contributed to unavoidable referrals. Adequate facilities or having more experienced doctors could have avoided 14.5% of the referrals. The low referral rate and very high level of appropriate referrals could indicate that primary care providers in the public sector played an effective role as gatekeepers in the Malaysian public healthcare system.
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Gatekeeping , Primary Health CareABSTRACT
This study was conducted to assess the referral patterns to specialist from general practitioners in health center and perceived needs of referred patients for specialist care in health center. The study subjects were 249 patients who visited to health centers and were referred to other medical facilities. The data were obtained from questionnaire survey which was conducted in Kyongjuu-city Health center, Seongju-Gun Health center and Koryong-Gun Health center in Kyongsangbuk-Do, from June 10 to october 17, 1995. The total referral rate was 2.7%. The proportion of patients who wished to be referred to medical specialists was 85.9%, and the proportion of patients referred by general practitioners in health centers was 14.1%. Among the patients who wished to be referred to medical specialists, 45.9% visited directly to health centers, 34.6% visited health centers via local clinics and 19.5% visited health centers to get referral permission only. The reasons for getting referral permission in health centers were easy geographical accessibility(34.6 %), easy to get referral permission in health centers(27.l%), and very difficult to get referral permission in local clinics(l6.4%). Among the diseases of referred patients, diseases of the musculoskeletal system and connective tissue were most prevalent on a whole, but diseases of nervous system and sensory organs were comparatively high among the patients who wished to be referred to medical specialists and infectious and parasitic diseases were comparatively high among the patients referred by general practitioners in health centers. The most favorable medical facility was general hospital including university hospital in both groups of patients who wished to be referred to medical specialist and the patient referred by general practitioners in health centers. Regarding the needs for specialist care in health center, 75.2% patients who wished to be referred to medical specialists and 74.3% of patients referred by general practitioners in health center wanted the specialist care. The most frequently requested speciality is internal medicine(47.1%), and then orthopedics and general surgery. Based on above results, this study revealed that the majority of patients referred from health center wished to be referred to medical specialists at their own will, so, referral system at health center level should be changed. And if specialist care in health center be provided, the medical care by internist could be provided first, and then that of orthopedics and general surgery could be provided. These kinds of medical cares could be covered by local clinicians as a part-time job on a voluntary basis.