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Can guidelines improve referral to elective surgical specialties for adults? A systematic review

By Aileen Clarke, N. Blundell, I. Forde, N. Musila, D. Spitzer, S. Naqvi and John Browne

Abstract

Aim To assess effectiveness of guidelines for referral for\ud elective surgical assessment.\ud Method Systematic review with descriptive synthesis.\ud Data sources Medline, EMBASE, CINAHL and Cochrane\ud database up to 2008. Hand searches of journals and\ud websites.\ud Selection of studies Studies evaluated guidelines for\ud referral from primary to secondary care, for elective\ud surgical assessment for adults.\ud Outcome measures Appropriateness of referral (usually\ud measured as guideline compliance) including clinical\ud appropriateness, appropriateness of destination and of\ud pre-referral management (eg, diagnostic investigations),\ud general practitioner knowledge of referral\ud appropriateness, referral rates, health outcomes and\ud costs.\ud Results 24 eligible studies (5 randomised control trials,\ud 6 cohort, 13 case series) included guidelines from UK,\ud Europe, Canada and the USA for referral for\ud musculoskeletal, urological, ENT, gynaecology, general\ud surgical and ophthalmological conditions. Interventions\ud varied from complex (“one-stop shops”) to simple\ud guidelines. Four randomized control trials reported\ud increases in appropriateness of pre-referral care\ud (diagnostic investigations and treatment). No evidence\ud was found for effects on practitioner knowledge. Mixed\ud evidence was reported on rates of referral and costs\ud (rates and costs increased, decreased or stayed the\ud same). Two studies reported on health outcomes finding\ud no change.\ud Conclusions Guidelines for elective surgical referral can\ud improve appropriateness of care by improving prereferral\ud investigation and treatment, but there is no\ud strong evidence in favour of other beneficial effects

Topics: RD
Publisher: BMJ Group
Year: 2010
OAI identifier: oai:wrap.warwick.ac.uk:2939

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