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Interpretations of referral appropriateness by senior health managers in five PCT areas in England : a qualitative investigation

By N. Blundell, Aileen Clarke and Nicholas Mays

Abstract

Aim To explore interpretations of “appropriate” and “inappropriate” elective referral from primary to secondary surgical care among senior clinical and non-clinical managers in five purposively sampled primary care trusts (PCTs) and their main associated acute hospitals in the English National Health Service (NHS). \ud \ud Methods Semi-structured face-to-face interviews were undertaken with senior managerial staff from clinical and non-clinical backgrounds. Interviews were tape-recorded, transcribed and analysed according to the Framework approach developed at the National Centre for Social Research using N6 (NUD*IST6) qualitative data analysis software. \ud \ud Results Twenty-two people of 23 approached were interviewed (between three and five respondents per PCT and associated acute hospital). Three attributes relating to appropriateness of referral were identified: necessity: whether a patient with given characteristics was believed suitable for referral; destination or level: where or to whom a patient should be referred; and quality (or process): how a referral was carried out, including (eg, investigations undertaken before referral, information contained in the referral and extent of patient involvement in the referral decision. Attributes were hierarchical. “Necessity” was viewed as the most fundamental attribute, followed by “destination” and, finally, “quality”. In general, but not always, all three attributes were perceived as necessary for a referral to be defined as appropriate. \ud \ud Conclusions For senior clinical and non-clinical managers at the local level in the English NHS,, three hierarchical attributes (necessity, appropriateness of destination and quality of referral process) contributed to the overall concept of appropriateness of referral from primary to secondary surgical care

Topics: R1
Publisher: BMJ Group
Year: 2010
OAI identifier: oai:wrap.warwick.ac.uk:3889

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Citations

  1. (2000). Variation in GP referral rates: what can we learn from the literature? Fam Pract doi
  2. (1992). Measuring referral rates.
  3. (1992). Patterns of referral: explaining variation. In:Roland
  4. (1986). A method for the detailed assessment of the appropriateness of medical technologies. doi
  5. (1996). Appropriateness in health care delivery: definitions, measurement and policy implications. CMAJ
  6. (2000). Appropriateness in health services. Report of a workshop. Koblenz (Germany): European Health 21,
  7. (2001). for Clinical Excellence (NICE). Referral advice: a guide to appropriate referral from general to specialist services.
  8. (2006). Referral management centres: promising innovations or Trojan horses? BMJ doi
  9. (1993). Qualitative data analysis for applied policy research. In:Bryman doi
  10. (2004). Physicians gaming the system: modern-day Robin Hood? Health Law Review
  11. (1991). Gaming the system. Dodging the rules, ruling the dodgers. Arch Intern Med doi
  12. (2010). Focus groups. Annu Rev Sociol 1996;22:129e52. 186 Qual Saf Health Care 2010;19:182e186. doi:10.1136/qshc.2007.025684 Original research group.bmj.com on

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