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Published in: BMC Health Services Research 1/2009

Open Access 01-12-2009 | Research article

Bridging the care continuum: patient information needs for specialist referrals

Authors: Carol L Ireson, Svetla Slavova, Carol L Steltenkamp, F Douglas Scutchfield

Published in: BMC Health Services Research | Issue 1/2009

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Abstract

Background

Information transfer is critical in the primary care to specialist referral process and has been examined extensively in the US and other countries, yet there has been little attention to the patient's perspective of the information transfer process. This cross-sectional study examined the quality of the information received by patients with a chronic condition from the referring and specialist physician in the specialist referral process and the relationship of the quality of information received to trust in the physicians.

Methods

Structured telephone interviews were conducted with a random sample of 250 patients who had experienced a referral to a specialist for the first visit for a chronic condition within the prior six months. The sample was selected from the patients who visited specialist physicians at any of the 500 hospitals from the National Research Corporation client base.

Results

Most patients (85%) received a good explanation about the reason for the specialist visit from the referring physician yet 26% felt unprepared about what to expect. Trust in the referring physician was highly associated with the preparatory information patients received. Specialists gave good explanations about diagnosis and treatment, but 26% of patients got no information about follow-up. Trust in the specialist correlated highly with good explanations of diagnosis, treatment, and self-management.

Conclusion

Preparatory information from referring physicians influences the quality of the referral process, the subsequent coordination of care, and trust in the physician. Changes in the health care system can improve the information transfer process and improve coordination of care for patients.
Literature
1.
go back to reference Cherry DK, Woodwell DA: National Ambulatory Medical Care Survey: 2006 Summary. Natl Health Stat Report. 2008, 3: 1-39.PubMed Cherry DK, Woodwell DA: National Ambulatory Medical Care Survey: 2006 Summary. Natl Health Stat Report. 2008, 3: 1-39.PubMed
2.
go back to reference Cleary PD, Edgman-Levitan S, Roberts M, Moloney TW, McMullen W, Walker JD, Delbanco TL: Patients evaluate their hospital care: a national survey. Health Aff (Millwood). 1991, 10 (4): 254-267. 10.1377/hlthaff.10.4.254.CrossRef Cleary PD, Edgman-Levitan S, Roberts M, Moloney TW, McMullen W, Walker JD, Delbanco TL: Patients evaluate their hospital care: a national survey. Health Aff (Millwood). 1991, 10 (4): 254-267. 10.1377/hlthaff.10.4.254.CrossRef
3.
go back to reference Piterman L, Koritsas S: Part I. General practitioner and specialist relationship. Intern Med Journ. 2005, 35: 430-434. 10.1111/j.1445-5994.2005.00855.x.CrossRef Piterman L, Koritsas S: Part I. General practitioner and specialist relationship. Intern Med Journ. 2005, 35: 430-434. 10.1111/j.1445-5994.2005.00855.x.CrossRef
4.
go back to reference Emanuel LL: The consultant and the patient-physician relationship. Arch Intern Med. 1994, 154: 1785-1970. 10.1001/archinte.154.16.1785.CrossRefPubMed Emanuel LL: The consultant and the patient-physician relationship. Arch Intern Med. 1994, 154: 1785-1970. 10.1001/archinte.154.16.1785.CrossRefPubMed
5.
go back to reference Williams TF, White KL, Fleming WL, Greenberg BG: The referral process in medical care and the university clinic's role. J Med Educ. 1961, 36: 899-907.PubMed Williams TF, White KL, Fleming WL, Greenberg BG: The referral process in medical care and the university clinic's role. J Med Educ. 1961, 36: 899-907.PubMed
6.
go back to reference Forrest CB, Glade GB, Baker AE, Bocian A, von Schrader S, Starfield B: Coordination of specialty referrals and physician satisfaction with referral care. Arch Pediatr Adolesc Med. 2000, 154: 499-506.CrossRefPubMed Forrest CB, Glade GB, Baker AE, Bocian A, von Schrader S, Starfield B: Coordination of specialty referrals and physician satisfaction with referral care. Arch Pediatr Adolesc Med. 2000, 154: 499-506.CrossRefPubMed
7.
go back to reference Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG: Communication breakdown in the outpatient referral process. J Gen Intern Med. 2000, 15: 626-631. 10.1046/j.1525-1497.2000.91119.x.CrossRefPubMedPubMedCentral Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG: Communication breakdown in the outpatient referral process. J Gen Intern Med. 2000, 15: 626-631. 10.1046/j.1525-1497.2000.91119.x.CrossRefPubMedPubMedCentral
8.
go back to reference Blankenship JC, Manapace FJ, Fox LS, Frey CM: Telephone reporting of the results of cardiac procedures: feasibility and primary care physician preferences. A J Med . 1999, 106: 521-526. 10.1016/S0002-9343(99)00073-X.CrossRef Blankenship JC, Manapace FJ, Fox LS, Frey CM: Telephone reporting of the results of cardiac procedures: feasibility and primary care physician preferences. A J Med . 1999, 106: 521-526. 10.1016/S0002-9343(99)00073-X.CrossRef
9.
go back to reference Barnes EA, Hanson J, Neumann CM, Nekolaichuk CL, Bruera E: Communications between primary care physicians and radiation oncologists regarding patients with cancer treated with palliative radiotherapy. J Clin Oncol. 2000, 18 (15): 2902-2907.PubMed Barnes EA, Hanson J, Neumann CM, Nekolaichuk CL, Bruera E: Communications between primary care physicians and radiation oncologists regarding patients with cancer treated with palliative radiotherapy. J Clin Oncol. 2000, 18 (15): 2902-2907.PubMed
10.
go back to reference Bodenheimer T: Coordinating care: a major (unreimbursed) task of primary care. Ann Intern Med. 2007, 147 (10): 730-731.CrossRefPubMed Bodenheimer T: Coordinating care: a major (unreimbursed) task of primary care. Ann Intern Med. 2007, 147 (10): 730-731.CrossRefPubMed
11.
go back to reference Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG: Communication breakdown in the outpatient referral process. J Gen Intern Med. 2000, 15: 626-631. 10.1046/j.1525-1497.2000.91119.x.CrossRefPubMedPubMedCentral Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG: Communication breakdown in the outpatient referral process. J Gen Intern Med. 2000, 15: 626-631. 10.1046/j.1525-1497.2000.91119.x.CrossRefPubMedPubMedCentral
12.
go back to reference Gandhi TK: Fumbled handoffs: one dropped ball after another. Ann Intern Med. 2005, 142 (5): 352-350.CrossRefPubMed Gandhi TK: Fumbled handoffs: one dropped ball after another. Ann Intern Med. 2005, 142 (5): 352-350.CrossRefPubMed
13.
go back to reference Casalino LP, Dunham D, Chin MH, Bielang R, Kistner EO, Karrison TG, Ong MK, Sarkar U, McLaughlin MA, Meltzer DO: Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results. Arch Intern Med. 2009, 169 (12): 1123-1129. 10.1001/archinternmed.2009.130.CrossRefPubMed Casalino LP, Dunham D, Chin MH, Bielang R, Kistner EO, Karrison TG, Ong MK, Sarkar U, McLaughlin MA, Meltzer DO: Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results. Arch Intern Med. 2009, 169 (12): 1123-1129. 10.1001/archinternmed.2009.130.CrossRefPubMed
14.
go back to reference Albertson GA, Lin CT, Kutner J, Schilling LM, Anderson SN, Anderson RJ: Recognition of patient referral desires in an academic managed care plan frequency, determinants, and outcomes. J Gen Intern Med. 2000, 15 (4): 242-247. 10.1111/j.1525-1497.2000.02208.x.CrossRefPubMedPubMedCentral Albertson GA, Lin CT, Kutner J, Schilling LM, Anderson SN, Anderson RJ: Recognition of patient referral desires in an academic managed care plan frequency, determinants, and outcomes. J Gen Intern Med. 2000, 15 (4): 242-247. 10.1111/j.1525-1497.2000.02208.x.CrossRefPubMedPubMedCentral
15.
go back to reference Albertson G, Lin C, Schilling L, Cyran E, Anderson S, Anderson RJ: Impact of a simple intervention to increase primary care provider recognition of patient referral concerns. Am J Manag Care. 2002, 8 (4): 375-381.PubMed Albertson G, Lin C, Schilling L, Cyran E, Anderson S, Anderson RJ: Impact of a simple intervention to increase primary care provider recognition of patient referral concerns. Am J Manag Care. 2002, 8 (4): 375-381.PubMed
16.
go back to reference Forrest CB, Shadmi E, Nutting PA, Starfield B: Specialty referral completion among primary care patients: results from the ASPN Referral Study. Ann Fam Med. 2007, 5 (4): 361-367. 10.1370/afm.703.CrossRefPubMedPubMedCentral Forrest CB, Shadmi E, Nutting PA, Starfield B: Specialty referral completion among primary care patients: results from the ASPN Referral Study. Ann Fam Med. 2007, 5 (4): 361-367. 10.1370/afm.703.CrossRefPubMedPubMedCentral
17.
go back to reference Keating NL, Green DC, Kao AC, Gazmararian JA, Wu VY, Cleary PD: How are patients' specific ambulatory care experiences related to trust, satisfaction, and considering changing physicians?. J Gen Intern Med. 2002, 17 (1): 29-39. 10.1046/j.1525-1497.2002.10209.x.CrossRefPubMedPubMedCentral Keating NL, Green DC, Kao AC, Gazmararian JA, Wu VY, Cleary PD: How are patients' specific ambulatory care experiences related to trust, satisfaction, and considering changing physicians?. J Gen Intern Med. 2002, 17 (1): 29-39. 10.1046/j.1525-1497.2002.10209.x.CrossRefPubMedPubMedCentral
18.
go back to reference Keating NL, Gandhi T, Orav EJ, Bates DW, Ayanian JZ: Patient characteristics and experiences associated with trust in specialist physicians. Arch Intern Med. 2004, 164 (9): 1015-1020. 10.1001/archinte.164.9.1015.CrossRefPubMed Keating NL, Gandhi T, Orav EJ, Bates DW, Ayanian JZ: Patient characteristics and experiences associated with trust in specialist physicians. Arch Intern Med. 2004, 164 (9): 1015-1020. 10.1001/archinte.164.9.1015.CrossRefPubMed
19.
go back to reference Fiscella K, Meldrum S, Franks P, Shields CG, Duberstein P, McDaniel SH, Epstein RM: Patient trust-is it related to patient-centered behavior of primary care physicians?. Med Care. 2004, 42 (11): 1049-1054. 10.1097/00005650-200411000-00003.CrossRefPubMed Fiscella K, Meldrum S, Franks P, Shields CG, Duberstein P, McDaniel SH, Epstein RM: Patient trust-is it related to patient-centered behavior of primary care physicians?. Med Care. 2004, 42 (11): 1049-1054. 10.1097/00005650-200411000-00003.CrossRefPubMed
20.
go back to reference Vermeire E, Hearnshaw H, Van Royen P, Denekens J: Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001, 26 (5): 331-342. 10.1046/j.1365-2710.2001.00363.x.CrossRefPubMed Vermeire E, Hearnshaw H, Van Royen P, Denekens J: Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001, 26 (5): 331-342. 10.1046/j.1365-2710.2001.00363.x.CrossRefPubMed
21.
go back to reference White P, Singleton A, Jones R: Copying referral letters to patients: the views of patients, patient representatives and doctors. Patient Educ Couns. 2004, 55 (1): 94-98. 10.1016/j.pec.2003.08.003.CrossRefPubMed White P, Singleton A, Jones R: Copying referral letters to patients: the views of patients, patient representatives and doctors. Patient Educ Couns. 2004, 55 (1): 94-98. 10.1016/j.pec.2003.08.003.CrossRefPubMed
22.
go back to reference Eaden JA, Ward B, Smith H, Mayberry JF: Are we telling patients enough? A pilot study to assess patient information needs in a gastroenterology outpatient department. Eur J Gastroenterol Hepatol. 1998, 10 (1): 63-67. 10.1097/00042737-199801000-00012.CrossRefPubMed Eaden JA, Ward B, Smith H, Mayberry JF: Are we telling patients enough? A pilot study to assess patient information needs in a gastroenterology outpatient department. Eur J Gastroenterol Hepatol. 1998, 10 (1): 63-67. 10.1097/00042737-199801000-00012.CrossRefPubMed
23.
go back to reference Crossing the Quality Chasm: A New Health System for the 21st Century. 2001, National Academy Press Crossing the Quality Chasm: A New Health System for the 21st Century. 2001, National Academy Press
24.
go back to reference Pett MA, Lackey NR, Sullivan JJ: Making Sense of Factor Analysis: The Use of Factor Analysis for Instrument Development in Health Care Research. 2003, SAGE PublicationsCrossRef Pett MA, Lackey NR, Sullivan JJ: Making Sense of Factor Analysis: The Use of Factor Analysis for Instrument Development in Health Care Research. 2003, SAGE PublicationsCrossRef
25.
go back to reference Nunnally JC, Bernstein IH: Psychometric Theory. 1994, New York: McGraw-Hill Nunnally JC, Bernstein IH: Psychometric Theory. 1994, New York: McGraw-Hill
26.
go back to reference Frisse ME, Holmes RL: Estimated financial savings associated with health information exchange and ambulatory care referral. J Biomed Inform. 2007, 40: S27-S32. 10.1016/j.jbi.2007.08.004.CrossRefPubMed Frisse ME, Holmes RL: Estimated financial savings associated with health information exchange and ambulatory care referral. J Biomed Inform. 2007, 40: S27-S32. 10.1016/j.jbi.2007.08.004.CrossRefPubMed
27.
go back to reference Hillestad R, Vigelow J, Bower A, Girosi F, Meili R, Scoville R, Taylor R: Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff (Millwood). 2005, 24 (5): 1103-1117. 10.1377/hlthaff.24.5.1103.CrossRef Hillestad R, Vigelow J, Bower A, Girosi F, Meili R, Scoville R, Taylor R: Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff (Millwood). 2005, 24 (5): 1103-1117. 10.1377/hlthaff.24.5.1103.CrossRef
28.
go back to reference Keating NL, Green DC, Kao AC, Gazmararian JA, Wu VY, Cleary PD: How are patients' specific ambulatory care experiences related to trust, satisfaction, and considering changing physicians?. J Gen Intern Med. 2002, 17 (1): 29-39. 10.1046/j.1525-1497.2002.10209.x.CrossRefPubMedPubMedCentral Keating NL, Green DC, Kao AC, Gazmararian JA, Wu VY, Cleary PD: How are patients' specific ambulatory care experiences related to trust, satisfaction, and considering changing physicians?. J Gen Intern Med. 2002, 17 (1): 29-39. 10.1046/j.1525-1497.2002.10209.x.CrossRefPubMedPubMedCentral
29.
go back to reference Keating NL, Gandhi T, Orav EJ, Bates DW, Ayanian JZ: Patient characteristics and experiences associated with trust in specialist physicians. Arch Intern Med. 2004, 164 (9): 1015-1020. 10.1001/archinte.164.9.1015.CrossRefPubMed Keating NL, Gandhi T, Orav EJ, Bates DW, Ayanian JZ: Patient characteristics and experiences associated with trust in specialist physicians. Arch Intern Med. 2004, 164 (9): 1015-1020. 10.1001/archinte.164.9.1015.CrossRefPubMed
30.
go back to reference Thom DH, Hall MA, Pawlson LG: Measuring patients' trust in physicians when assessing quality of care. Health Aff (Millwood). 2004, 23 (4): 124-132. 10.1377/hlthaff.23.4.124.CrossRef Thom DH, Hall MA, Pawlson LG: Measuring patients' trust in physicians when assessing quality of care. Health Aff (Millwood). 2004, 23 (4): 124-132. 10.1377/hlthaff.23.4.124.CrossRef
31.
go back to reference Schoen C, Osborn R, Huynh PT, Doty M, Peugh J, Zapert K: On the front lines of care: primary care doctors' office systems, experiences, and views in seven countries. Health Aff (Millwood). 2006, 25 (6): 555-571. 10.1377/hlthaff.25.w555.CrossRef Schoen C, Osborn R, Huynh PT, Doty M, Peugh J, Zapert K: On the front lines of care: primary care doctors' office systems, experiences, and views in seven countries. Health Aff (Millwood). 2006, 25 (6): 555-571. 10.1377/hlthaff.25.w555.CrossRef
Metadata
Title
Bridging the care continuum: patient information needs for specialist referrals
Authors
Carol L Ireson
Svetla Slavova
Carol L Steltenkamp
F Douglas Scutchfield
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2009
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-9-163

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