Factors contributing to effective referral systems for patients with non-communicable disease: evidence-based practice

Referrals are an important part of the management of patients, particularly those with a chronic non-communicable disease (NCD), as it ensures the patient has continuous care. The main objective of this research is to develop a tool for assessing referral systems between primary and secondary care. The research question addressed in this paper is ‘what constitutes an effective evidence-based practice (EBP) referral system?’ Two steps were undertaken in this paper. In the first step, a question was formulated using a modified version of the PICOT (populations, interventions, comparison, outcome, and time) format, where only the PIO (patient, intervention and outcome) steps were used. The research question was used to search databases for systematic reviews on the factors contributing to effective referral systems for patients between primary and secondary care. The final part of the first step was to extract and synthesise data. The second step was to design an assessment tool that was able to assess referral studies in terms of the quality of the referral system. Three systematic reviews were included in this study, after being examined against the inclusion and exclusion criteria. The criteria for EBP referral systems consist of ten factors. The ten factors identified that an EBP referral system should be safe, timely, effective, efficient, patient-centred, and equitable; a referral letter should be structured; referral letter guidelines should be disseminated; a central computerised system should be used, and inclusion criteria of referred patients should be given in a referral letter. This ten-factor assessment tool will be used to assess referral systems as it is based on EBP from high quality studies and organisations. Using this tool could help researchers of referral systems to measure the problems faced in the referral system in their practice and address these problems, based on the ten factors.