REFERRAL BEHAVIOUR OF PRIMARY CARE DOCTORS TO RHEUMATOLOGY CLINIC IN MALAYSIA

BackgroundThe workload at rheumatology clinics have been growing relentlessly and an audit on new.referrals helps to identify referral behaviour of primary care doctors and improvement can be done by providing further training.ObjectivesTo audit on new referral cases to rheumatology clinic from 2020-2022 and to identify new cases with misdiagnosis for future training purpose.MethodsThis was a retrospective study. The medical records of all new referral to rheumatology clinic Hospital Sultan Ismail and Hospital Pakar Sultanah Fatimah from 1st January 2020 to 31th November 2022 were reviewed. The referral diagnosis and final diagnosis were identified and analysed.ResultsThere were total of 927 new cases referral throughout the 35 months during Covid-19pandemic. Majority of them were diagnosed to have rheumatoid arthritis (217/927)followed by systemic lupus erythematosus (190/927), psoriatic arthritis (147/927),gout (62/927), osteoarthritis (58/927), systemic sclerosis (25/927), ankylosing spondylitis (25/927), soft tissue rheumatism (24/927), Sjogren syndrome (24/927),mixed connective tissue disease (14/927), vasculitis (11/927), fibromyalgia (10/927),polymyositis (7/927) and miscellaneous (39/927).45 out of the new cases were diagnosed as unlikely rheumatic diseases. There were 29pending cases awaiting final diagnosis.212 of the referrals were identified as misdiagnosis with the highest as nodal osteoarthritis.(55/212) followed by unlikely rheumatic disease (43/212), soft tissue rheumatism (24/212),psoriatic arthritis (20/212), Sjogren syndrome (14/212), gout (8/212), rheumatoid arthritis (7/212), fibromyalgia (6/212), systemic lupus erythematosus (5/212), ankylosing spondylitis (4/212), mixed connective tissue disease (3/212), systemic sclerosis (2/212), polymyositis (2/212) and others (19/212): diffuse idiopathic skeletal hyperostosis, hypermobility syndrome, RS3PE syndrome, idiopathic uveitis, graft versus host disease, juvenile idiopathic arthritis, antiphospholipid syndrome, hypothyroidism, post streptococcal arthritis, prolapsed intervertebral disc, cerebrovascular disease, traumatic sternoclavicular joint subluxation, ledderhose disease, paraspinal muscle spasm and viral myalgia).ConclusionNodal osteoarthritis and soft tissue rheumatism can be great mimicker for inflammatory.arthritis and if wrongly diagnosed will lead to unnecessary anxiety or wrong treatment. More training is needed to improve clinical skills amongst primary care doctors.ReferencesNA.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

One stop vein clinic

Team involved are:Vascular surgery department in collaboration with the radiology department.Kent and Canterbury hospitalEast Kent University Foundation TrustIn the current practice under the vascular clinic, a patient with venous disease must pass through a journey of 3 steps.An outpatient appointment initially for clinical examination and evaluation of stage of his venous disease,Referral to radiographer for a duplex ultrasound scan (to rule out thrombosis and clarify the level of the disease)Further appointment with surgeon for receiving their final diagnosis and being listed for treatment.This unfortunately, has cause an unacceptable considerable delay in providing our service and treating those patients. The delay between referral to diagnosis exceeded more than 8 months. The main reasons were:Shortage of radiographersCOVID backlogTime consumed between these 3 appointmentsAssessment of issue and analysis of its causesWe analysed the factors of the cause of the delay in management of patients with venous diseases and it showed that the main reason for delay is delay in ultrasound scan, (the second step in the patient journey to gain the diagnosis).-We faced a period when our only radiographer resigned and we stayed without radiographers in the department for several months until the management were able to recruit a new radiographer. This of course has created a huge impact on our service.Of course the covid has impacted badly on our service. As we cancelled all the patient appointments with venous diseases and concentrated in life or limb threatening conditions only.-The inherited pathway has an element in delay as well as the time consumed between these 3 appointments may exceed several months.ImpactThe project is to merge all the three appointments in only one appointment where the patient will be examined and have the ultrasound in same setting. Thus, the patient will be able to have the outcome immediately in the same session without delay.The main problem , is that there's no enough radiographers to join the vascular surgeons in their clinic to carry on the scan simultaneously. Hence, the idea came to light, that the scan should be done by the vascular surgeons themselves.InterventionThis project helped me to act as a leader and express the ideas without fear and come out of my comfort zone.-We have been taught by the eclips team, To be a good leader , you have to start with your self.Thus, when I started this project, I had to learn the ultrasound skills and collaborate with the radiology department to ease the steps for the rest of the vascular team who would like to follow my steps and gain the ultrasound skill.Involvement of stakeholders, such as patients, carers or family members:The stakeholders areThe patientsFor the patient benefit, being assessed in one clinic, is believed to reduce the stress of awaiting diagnosis for such problem, in addition to some other merits like less time off work for patients, and less transportation cost.The vascular surgeons.The ultrasound is a cornerstone in the modern vascular era, and learning the skills for this tool will in fact benefit the surgeons in their daily work as they can scan the patient themselves particularly in case of emergency.The radiographers and radiology department.It is believed that scanning the patient by the vascular surgeons for the venous diseases will reduce the pressure on the radiology department for a huge list of patients awaiting scan .The management–Saving administration resources, by reducing the clinic cost and reducing the number of clinics.–Reduce the need for hiring locum radiographers or out of hours shifts to reduce the number of patients awaiting their venous scan.–To achieve the 18 months NHS timeframe between referral to diagnosis.–Cost effective measure to use the resources which is already present (portable ultrasounds) without need to buy a new machine or use another room for the scanning.Key MessagesThe main message is that there's a lot of brilliant ideas to improve the service in NHS. Giving us the chance to express these ideas is amazing. All appreciation to eclips team who helped us to start such projects.When I started describing my idea to my line manager, I was astonished that he was completing my words as if he was reading my mind. His support was outstanding and he eased the project steps to me.I hope my project will come to light and to be implemented in other sites as in my opinion, it will help plenty of patients who are struggling to manage their venous disease because of unaccepted delay , unfortunately a lot of them have no choice but to go the private sector which is extremely expensive.Lessons learntMy retrospective audit is still ongoing.There are 2 elements in my project.The first one is subjective, as I had to start with my self.I had a very limited ultrasound experience. So, I have done some search until I found a good centre for ultrasound course for vascular diseases. I applied and had my basic ultrasound skills.The challenge is how to apply this knowledge to the patients where I'm not yet confident to give a report. So, the collaboration with the radiology department was started and they were extremely helpful and supportive as they were kindly supported us with one of the best radiologist consultant to supervise me until I feel confident to do the scan independently. This step took around 2 months until is has been successful.-The second element is objective. As collecting the data during the working hours with busy rota is challenging.Measurement of improvementTo measure the effect of our improvement.We looked at the numbers of patients awaiting venous scan before starting the project (February 2022),. the number was around 230 patients.I managed to share my experience to my colleagues and one of them was interested and joined me. we as 2 speciality vascular surgeon in a half day once weekly clinic , were able to complete a venous scan of 105 patients (almost 50% of the number) in just 6 months.-Currently , we are running an audit to assess the time difference before and after the implementation of the project and hopefully, the data will come to light soon.Strategy for improvementThe timeline for the project is 6 month, which have been completed successfully as myself and the other vascular surgeon are able to perform the venous scan independently.The data is analysed at the moment and will soon be published.

Connecting children with birth defects to health and social service programs: A collaboration between the Texas Birth Defects Registry and agency social workers.

BACKGROUND: Timely referral to services for children born with birth defects can improve health outcomes. Birth defects surveillance registries may be a valuable data source for connecting children to health and social service programs. METHODS: Population-based, state-wide data from the Texas Birth Defects Registry (TBDR) at the Texas Department of State Health Services (DSHS) were used to connect children 9-18 months old, born with select birth defects with DSHS social workers. The social workers reviewed developmental milestones and referred children and their families to various health and social service programs. We tabulated the proportions of children meeting milestones and referral characteristics by referral program type and type of birth defect. RESULTS: Social workers reached 67% (909/1,362) of identified families. Over half of children (54%, 488/909) were not meeting the developmental milestones for their age. Social workers provided over 3,000 program referrals, including referring 21% (194/909) of children to Early Childhood Intervention (ECI) and 28% (257/909) to case management. CONCLUSION: Our results illustrate a method of leveraging a birth defects surveillance system for referral services. Given the large number of referrals made, our findings suggest that birth defects registries can be a valuable source of data for referring children to programs.

Developing and Implementing a Depression Screening and Referral Protocol Among College Students

Depression is prevalent among college students but remains underrecognized and undertreated. Evidence supports universal depression screening among college students combined with follow-up systems to ensure appropriate diagnosis and management. Screening tools may include versions of the Patient Health Questionnaire, and follow-up systems may include following up with the current provider or referring the student to a mental health specialist. The purpose of this quality improvement project was to promote the identification of college students with depression and subsequent appropriate referrals.

Navigating health systems for burn care: Patient journeys and delays in Uttar Pradesh, India.

BACKGROUND: India has one of the highest burden of burns. The health systems response to burn care is sometimes patchy and highly influenced by social determinants. Delay in access to acute care and rehabilitation adversely affects recovery outcomes. Evidence on underlying factors for delays in care are limited. In this study, we aim to explore patients' journeys to analyse their experiences in accessing burn care in Uttar Pradesh, India. METHODS: We conducted qualitative inquiry using the patient journey mapping approach and in-depth interviews (IDI). We purposively selected a referral burn centre in Uttar Pradesh, India and included a diverse group of patients. A chronological plot of the patient's journey was drawn and confirmed with respondents at the end of the interview. A detailed patient journey map was drawn for each patient based on interview transcripts and notes. Further analysis was done in NVivo 12 using a combination of inductive and deductive coding. Similar codes were categorised into sub-themes, which were distributed to one of the major themes of the 'three delays' framework. RESULTS: Six major burns patients (4 female and 2 males) aged between 2 and 43 years were included in the study. Two patients had flame burns, and one had chemical, electric, hot liquid, and blast injury, respectively. Delay in seeking care (delay 1) was less common for acute care but was a concern for rehabilitation. Accessibility and availability of services, costs of care and lack of financial support influenced delay (1) for rehabilitation. Delay in reaching an appropriate facility (delay 2) was common due to multiple referrals before reaching an appropriate burn facility. Lack of clarity on referral systems and proper triaging influenced this delay. Delay in getting adequate care (delay 3) was mainly due to inadequate infrastructure at various levels of health facilities, shortage of skilled health providers, and high costs of care. COVID-19-related protocols and restrictions influenced all three delays. CONCLUSIONS: Burn care pathways are adversely affected by barriers to timely access. We propose using the modified 3-delays framework to analyse delays in burns care. There is a need to strengthen referral linkage systems, ensure financial risk protection, and integrate burn care at all levels of health care delivery systems.

The state of the faecal immunochemical test in symptomatic patients in the UK

In its 2015 NG12 guidance, NICE recommended the use of guaiac-based faecal occult blood test (gFOBT) and not FIT in primary care to triage patients with low-risk symptoms for cancer, due to paucity of evidence on FIT diagnostic accuracy at the time.1 But as evidence on FIT efficacy in symptomatic patients continued to emerge, gFOBT was replaced with FIT in NICE 2017 DG30 guidance.2 However, this recommendation was not extended to patients with high-risk symptoms for cancer or rectal bleeding.2 Since then, several pioneering centres in the UK, including centres in Nottingham, Oxfordshire and Tayside in Scotland, introduced FIT in patients with high and low risk symptoms using record linkage as part of service development projects, and reported promising results.3–5 At the same time, three large research studies were conducted in England, investigating the diagnostic accuracy of FIT in high and low risk symptomatic patients and reporting similar results.6–8 Two recent meta-analyses evaluated this and other evidence of the diagnostic accuracy of FIT.9,10 The key message from these studies remains remarkably consistent: The diagnostic accuracy of this test is, counter-intuitively, barely improved by the addition of other clinical characteristics into a risk-score.3,11Despite these encouraging results, there has been reluctance on the part of some groups in the UK, including NHS England, to recommend the use of FIT in the high-risk symptomatic patients because of concerns about missing cancer. Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study.

Ocular trauma, visual acuity related to time of referral and psychosocial determinants, during COVID‑19 pandemic: A prospective study

The aim of the present study was to explore the associations between visual outcomes of ocular injury patients in a tertiary hospital unit with clinical and demographic variables and to evaluate the psychosocial impact of the injury on the patients. An 18-month prospective study of 30 eye-injured adult patients was conducted in the General University Hospital of Heraklion, Crete, a tertiary referral hospital. All severe eye injury case information was prospectively collected between February 1, 2020 and August 31, 2021. Best corrected visual acuity (BCVA) was labelled not poor (>0.5/10 or >20/400 on the Snellen scale, <1.3 in LogMAR scale) and poor (≤0.5/10 or ≤20/400 on the Snellen scale, ≥1.3 on the LogMAR equivalent). Data regarding participants' perceived stress levels, by using Perceived Stress Scale 14 (PSS-14), were collected prospectively, one year after study end. Out of 30 ocular injury patients selected, 76.7% were men and most of them were self-employed and private or public sector workers (36.7%). Not poor final BCVA was related to not poor initial BCVA [odds ratio (OR) 1.714;P=0.006]. No statistical associations were found between visual outcome and demographic or clinical factors, but not poor final BCVA was associated with improved self-reported psychological condition of the sufferers, as examined by a questionnaire sheet developed to collect information for study purpose (8.36/10 vs. 6.40/10;P=0.011). No patient reported job loss or changed work status following the injury. Not poor initial BCVA was a significant predictor for not poor final visual outcomes (OR 1.714;P=0.006). Patients with not poor final BCVA expressed higher levels of positive psychology (8.36/10 vs. 6.40/10;P=0.011) and less fear of eye injury repetition (64.0 vs. 100.0%;P=0.286). Not poor final BCVA was associated with low PSS-14 scores one year after study end (77.3 vs. 0.0%, P=0.003). Collaboration between ophthalmologists, mental health professionals and primary care team may be important in order to help patients to cope with the psychosocial burden sequel to eye trauma. [ FROM AUTHOR] Copyright of Experimental & Therapeutic Medicine is the property of Spandidos Publications UK Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The effect of the SARS-CoV-2 pandemic on suspected cancer referrals at a regional head and neck unit

The novel coronavirus SARS-CoV-2, initially identified in late 2019 as a small case cluster, has rapidly become a global pandemic. Government restrictions, closure of primary care services, interruption of cancer screening programmes, and fear of contracting the virus have demonstrably led to a reduction in referrals for suspected cancer and delays to treatment across the United Kingdom. A retrospective analysis was carried out on suspected cancer referrals to the maxillofacial service at Aberdeen Royal Infirmary during the 12 months from March 2020, and compared with the 12 months prior. Suspected cancer referrals reduced by 38.6% (p < 0.001) during this period, with a reduction in the percentage referred by General Dental Practitioners. Further analysis shows a proportionate reduction in squamous cell carcinoma diagnoses, with other diagnoses remaining stable. Time from referral to first appointment, biopsy, and treatment showed no change. Stage at diagnosis and treatment modality was also unaffected. Assuming no change to the incidence of head and neck malignancies, over a third of new malignancies may have been undiagnosed during the 12 months from March 2020. Evidence for the impact of the pandemic is likely to become apparent as services return to pre-pandemic levels and these patients begin to present.Copyright © 2021 The Authors

Teledermoscopy – An Emerging Technology for Skin Cancer Detection

Dermatology is facing a worsening scarcity of providers, especially since the onset of the COVID-19 pandemic. With lengthening waiting periods for skin cancer screening examinations, there is a distinct need for alternatives to in-person evaluation. Delayed diagnosis is associated with poorer outcomes, especially in melanoma. Teledermatology has the potential to prevent the increased morbidity and mortality associated with late-stage diagnosis, especially when utilized with dermoscopy. In the literature, this novel field of "teledermoscopy” has exhibited accuracy and reliability comparable to face-to-face visits and is a promising alternative intervention for those who require triaging or for patients who are unable to access in-person care (rural, underserved populations). Although the early data is promising, formal guidelines for acquisition and interpretation of dermatoscopic images need to be established before wider implementation is possible. With standardization, use at-home or in in primary care offices will with such standardization, may relieve some of the pressure on an overburdened dermatologic care system and help patients who require urgent care to be seen more expediently.

Journal club

Patients often did not understand the diagnostic approach taken, for example, feeling advanced imaging was required and not appreciating the blood tests and CXR were being used to exclude cancer. A retrospective cohort study by Wang et al (Respiration 2022;101:553) looked at the short-term and long-term effects of antibiotic prescribing on treatment failure (repeat steroid prescription within 30 days) and re-exacerbations (prescription of steroids and or antibiotics between 30 days and 1 year). Saab et al (Nature Prim Care Respir Med 2022;32:42) completed a systematic review of seven studies investigating strategies that help primary healthcare professionals (HCPs) recognise and refer suspected LC patients quickly.

Underused Physical Therapy Services in Primary Care Settings: An Overview

The combined effects of longer life, noncommunicable diseases, and injuries increase the need for rehabilitation services. Although physical therapists' unique skill set on movement-related dysfunction allows for broad contributions to health care, physical therapy (PT) remains underutilized. This article situates the problem within the broader primary care context, focusing on PT's ability to mitigate disability and dysfunction in complex syndromes including pelvic floor incontinence, vertigo, cancer, chronic neuromusculoskeletal pain, and long coronavirus disease (ie, lingering effects after acute coronavirus disease infection passes). The path from PT research to clinical implementation remains dependent on factors beyond research evidence. This overview underscores the need to address this evidence to practice gap.

Social distance compliance and perceived importance of online YouTube diabetes prevention programs

This quantitative, nonexperimental survey was designed using a five-point Likert scale to measure the differences in the perceived importance scores for enrollment practices into nationally accredited YouTube diabetes prevention programs, or YouTube DPP, among online U.S. adult participants during the COVID-19 pandemic based on the social cognitive framework and was validated with Cronbach's alpha. G* Power analysis for alpha level = 0.05, standard power = 0.08, and the effect size = 0.25 was calculated for a target population of over 100,000. Responses (i.e., N = 258) from the COVID-19 Blood Sugar Wellness Survey were uploaded from SurveyMonkey. The perceived important scores of the participants were categorized into five social distance compliance groups. Descriptive statistics and a one-way analysis of variance (ANOVA) were used and the perceived important scores between the social distance compliance groups were observed to be significantly different, F (4, 253) = 7.36, p < .001, eta2 = 0.104. Based on Tukey's post hoc test, there were higher perceived importance scores for compliant, highly compliant, and always compliant groups when compared to low compliance group scores. Also, COVID-19 mandates impacted the participant's interest to enroll into YouTube DPP when presented with face-to-face (36.8%) or online doctor referrals (22.5%), program insurance coverage (30.6%), and programs with smartphone compatibility (27.9%). Percentages below 20% were classified as of low interest. Thus, policy makers should devise program incentives for clinician referrals, insurance coverage, and smartphone applications to increase enrollment rates into nationally accredited YouTube DPP. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Campus travel health services

Travel and students are inextricably linked. The college years are a time when students want to explore the unfamiliar and learn more about the outside world. The benefits of travel are enormous and something any campus would want to encourage. At the same time, however, colleges have a responsibility to protect the health and safety of students as well as the broader community from any negative consequences of travel. It can be quite challenging to develop travel health programs as various models exist and planning requires addressing issues such as staffing levels and training, budget, coordination with various stakeholders, and community resources. Providing appropriate pre- and post-travel care mandates a comprehensive risk analysis and evidenced-based risk mitigation strategies performed by trained travel health staff. © Springer Nature Switzerland AG 2021.

Screening tool to improve patient referral to acute surgical care from accident and emergency

IntroductionThis study aimed, first, to audit the appropriateness of surgical referrals to an acute surgical unit for urgent assessment and, second, to devise a screening tool for use in the emergency department to categorise patients into those who need an urgent surgical review and those who can be seen in an ambulatory setting within the next few days.MethodsThe first phase of the study was an audit of surgical referrals between 1 and 18 February 2020 to check the appropriateness of the surgical referral. In the second phase, a tool was designed to screen patients who did not require urgent surgical review and could be seen in the ambulatory clinic. A prospective questionnaire study was conducted from 1 February to 24 March 2020 with patients who were admitted to an acute surgical ward. Based on responses to the screening tool, patients were given the outcome of whether they can be discharged and seen in an ambulatory clinic. The accuracy of the screening tool outcome was assessed and compared with actual patient discharge outcomes by the surgical team evaluating patients' electronic medical records.ResultsIn the first audit of referrals to the acute surgical ward, 206 patients were referred to the acute surgical unit and seen by the senior surgeon. Of these, 142 (68.9%) were discharged on the same day with or without follow-up in the ambulatory surgical clinic. In the prospective questionnaire phase of the study, 98 patients completed the questionnaire. The most common presentation was abdominal pain (n=60) followed by urological symptoms (n=11), symptoms of hernia complication (n=10), abscess (n=7), testicular pain (n=2) and trauma (n=2). Of the patients discharged on the same day, 50% were given ambulatory care appointments and 50% were discharged with no further follow-up. The sensitivity and specificity of the screening tool were 100% and 60.7%, respectively;the overall accuracy was 88.4%.ConclusionA large proportion of patients who are referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool used for acute surgical referral had reasonable sensitivity and high specificity to screen patients who can be seen in ambulatory clinics. At the same time, it identified patients who were unwell and required urgent surgical admission.

Ocular trauma, visual acuity related to time of referral and psychosocial determinants, during COVID­19 pandemic: A prospective study.

The aim of the present study was to explore the associations between visual outcomes of ocular injury patients in a tertiary hospital unit with clinical and demographic variables and to evaluate the psychosocial impact of the injury on the patients. An 18-month prospective study of 30 eye-injured adult patients was conducted in the General University Hospital of Heraklion, Crete, a tertiary referral hospital. All severe eye injury case information was prospectively collected between February 1, 2020 and August 31, 2021. Best corrected visual acuity (BCVA) was labelled not poor (>0.5/10 or >20/400 on the Snellen scale, <1.3 in LogMAR scale) and poor (≤0.5/10 or ≤20/400 on the Snellen scale, ≥1.3 on the LogMAR equivalent). Data regarding participants' perceived stress levels, by using Perceived Stress Scale 14 (PSS-14), were collected prospectively, one year after study end. Out of 30 ocular injury patients selected, 76.7% were men and most of them were self-employed and private or public sector workers (36.7%). Not poor final BCVA was related to not poor initial BCVA [odds ratio (OR) 1.714; P=0.006]. No statistical associations were found between visual outcome and demographic or clinical factors, but not poor final BCVA was associated with improved self-reported psychological condition of the sufferers, as examined by a questionnaire sheet developed to collect information for study purpose (8.36/10 vs. 6.40/10; P=0.011). No patient reported job loss or changed work status following the injury. Not poor initial BCVA was a significant predictor for not poor final visual outcomes (OR 1.714; P=0.006). Patients with not poor final BCVA expressed higher levels of positive psychology (8.36/10 vs. 6.40/10; P=0.011) and less fear of eye injury repetition (64.0 vs. 100.0%; P=0.286). Not poor final BCVA was associated with low PSS-14 scores one year after study end (77.3 vs. 0.0%, P=0.003). Collaboration between ophthalmologists, mental health professionals and primary care team may be important in order to help patients to cope with the psychosocial burden sequel to eye trauma.

Challenges and opportunities for medical referrals at a mobile community health clinic serving sexual and gender minorities in rural South Carolina: a qualitative approach.

BACKGROUND: Sexual and gender minorities (SGM) in the Southern United States face challenges in accessing sexual and gender affirming health care. Alternative care models, like inclusive mobile clinics, help mitigate barriers to care for SGM. There is limited data in the literature on the experience of medical referral processes for SGM individuals accessing services from mobile health clinics. AIMS AND OBJECTIVES: The purpose of this study is to describe the medical referral experiences of SGM clients and their providers at a mobile health clinic in the Southern United States. METHODS: We recruited English-speaking individuals who provided care or received care from the mobile health clinic in South Carolina between June 2019 and August 2020. Participants completed a brief demographic survey and a virtual in-depth, semi-structured individual interview. Data analysis was conducted using an iterative process to generate codes, categories, and themes. Data collection and analysis were terminated once thematic saturation was achieved. RESULTS: The findings from this study indicated that the mobile health clinic had an inconsistent referral process that was largely dependent on providers' knowledge. Furthermore, clients and providers expressed individual barriers to the referral process, such as financial barriers, and opportunities to improve the referral process, such as an opt-in follow-up from the mobile clinic and increased mobile clinic resources. CONCLUSION: The findings in this study underscore the importance of having mobile clinics create a structured referral process that all medical providers are familiar with, and the value of hiring patient navigators that can support and refer clients to care that goes beyond the mobile health clinic setting.

Preventing Homelessness Through the National Call Center for Homeless Veterans: Analysis of Calls and Service Referrals.

OBJECTIVE: This study was the first to examine the characteristics and referral outcomes for veterans calling the National Call Center for Homeless Veterans (NCCHV). METHODS: The authors analyzed data from NCCHV and U.S. Department of Veterans Affairs (VA) health care records. RESULTS: Between December 2018 and October 2020, the NCCHV received 266,100 messages, with no major increase in the first 6 months of the COVID-19 pandemic. Of 110,197 veterans who contacted NCCHV, 69.6% were at risk for homelessness, and 20.1% were homeless. Most contacts (90.2%) resulted in a referral or transfer to a local resource. About 59.5% of NCCHV veterans had a medical record in the Veterans Health Administration; their use of homeless programs increased from 25.9% to 81.3%. Uses of mental health services, substance use treatment, and medical services showed small-to-moderate increases after NCCHV contacts. CONCLUSION: NCCHV is important for linking veterans to health and social care. Additional work is needed to assess veterans' outcomes after an NCCHV contact.

Developing Staff Referral Pathways to Aid in Proactive Management and Maintenance of Student Health and Wellbeing

The escalation of the COVID-19 situation throughout 2021 saw a dramatic increase in the number of ad-hoc referrals and requests submitted to the Student Health and Wellbeing (SHW) team at La Trobe University. While the SHW team was pleased to be receiving these referrals and requests, the incomplete nature of many of the requests made it incredibly difficult for them to follow up. A standardised form was developed to better enable non-clinical and all university staff to request consultations, make referrals, and effectively hand over students of concern to the SHW team for wellbeing support. Although a challenge to develop appropriately, this form has seen enormous success and has improved service delivery and capacity to an unprecedented level. Although somewhat counterintuitive, by standardising the requests and referrals process, the team were better able to deliver non-standard, individualised support for the at-risk and distressed students who required it. © 2022, Australian and New Zealand Student Services Association. All rights reserved.

Family Physicians Are Using Neighborhood Navigator to Address Social Determinants of Health

Social determinants of health are crucial drivers of health outcomes and inequities in the United States and account for approximately 80% of health outcomes, compared with only 20% for health care.1 Family physicians are increasingly asked to assess social needs and connect patients with appropriate resources. One commonly used resource referral platform is Aunt Bertha/findhelp, which was adopted by the American Academy of Family Physicians and branded as the Neighborhood Navigator tool in 2018. We analyzed more than 168,000 searches between November 2018 and April 2022 to identify patterns that may inform the direction of policy, funding, education, and resource allocation.