Referral and Consultation

BACKGROUND

Waiting time of patients from a consult with a primary care physician to a specialist is poorly understood. It is one indicator of health service delivery and patient satisfaction. Patients consider waiting for a specialist consult for more than three months too long and unacceptable.

To describe the sociodemographic and clinical factors associated with length of referral waiting time.

Cross-sectional retrospective chart review of patient records in a tertiary government hospital from 2015 to 2019.

A total of 366 charts were reviewed. Many of the patients referred to other specialty clinics were middle-aged adults and females. Median wait times for medical and surgical specialties were 11 (IQR: 0-29) and 18 (IQR: 6-35) days, respectively (p=0.003). Nutrition, rehabilitative medicine, and family health unit received the most number of referrals among non-surgical fields. Ophthalmology, otorhinolaryngology, and general surgery received the highest number of referrals among the surgical fields. Referral waiting times were longest for cardiology (median: 125, IQR: 91-275 days) and shortest for nutrition (median: 0, IQR: 0-6 days).

Waiting times from a primary care clinic to a specialty clinic at a tertiary government hospital vary based on urgency, specialty clinic, purpose of referral, presence of comorbidities, and chronicity of condition. Clinical factors found to be significantly associated with referral waiting time include urgency, type of clinic, and purpose of referral.

In this paper strategic planning is applied for effective management to improve hospital income. Though community hospital has been set up for improving the health status of community, it must be trying to increase income for continuing with referral hospital in the community. The most useful tool of management to do this purpose is thought of strategic planning. Therefore this paper developed strategic planning a typical community hospital, which for it presenting the strategic planning process and developing the simulation model for evaluation of strategic alternatives. In the result it is represented that admission rate is the most sensitive to hospital operating income among the important variables in the model. And simulation by changing the parameter could estimate the yearly hospital income in the response of alternatives. This strategic planning simulation model has had constraints as number of date but also significant such as evaluating the alternatives by quantitative model and at first applying the hospital in our country.
Hospitals, Community* ; Referral and Consultation

This article overviews unethical publishing practices in connection with the pressure to publish more. Both open-access and subscription publishing models can be abused by 'predatory' authors, editors, and publishing outlets. Relevant examples of ‘prolific’ scholars are viewed through the prism of the violation of ethical authorship in established journals and indiscriminately boosting publication records elsewhere. The instances of ethical transgressions by brokering editorial agencies and agents, operating predominantly in non-Anglophone countries, are presented to raise awareness of predatory activities. The scheme of predatory publishing activities is presented, and several measures are proposed to tackle the issue of predatory publishing. The awareness campaigns by professional societies, consultations with information facilitators, implementation of the criteria of best target journals, and crediting of scholars with use of integrative citation metrics, such as the h-index, are believed to make a difference.
Authorship ; Publications ; Referral and Consultation

No abstract available.
Humans ; Referral and Consultation*

No abstract available.
Humans ; Referral and Consultation*

Currently, most of pregnant women considered the fetal care. The education level was direct proportional with the rounds of pregnant consultation. However, the regular indicator of round of fetal and pregnant consultation remainly was low; the rate of pregnant women had 2 or 3 rounds of fetal and pregnant consultation was 41,6% while rate of pregnant women without fetal and pregnant consultation was 28,3%.
Pregnant Women ; Referral and Consultation

Subject: patients with ages of 65 and lower from 1/3-15/4/1998 in Thñy nguyªn and Tiªn l·ng district hospitals, Hi phßng province. Method: cross sectional study; sample size: 1000 patients. Results: 10% patients with health insurance complain about the physician’s attitude in the out patient consultation where as no patients without health insurance complains about the physician’s attitude. In both hospitals, there are 50% out patient with health insurance and 10% in patients with health insurance who said that the prescribed drugs are mainly the domestic drugs, even not enough drugs so patients with health insurance must buy additional drugs
therapeutics ; Referral and Consultation

Background: Bypass, is a pattern of seeking health care outside the local community where primary health care facilities are not efficiently utilized. It is common practice for patients to go directly to secondary or tertiary health facilities for primary health concerns, causing heavy traffic at the higher level facilities and corresponding over-utilization of resources. Objective: This study aimed to determine factors associated in the bypass of health care facilities among outpatient department patients and to identify health care facility factors perceived important among patients. Method: The study employed self-administered questionnaire with the assistance of trained research assistants among patients who sought consult at the Baguio General Hospital and Medical Center Outpatient Department during the study period of August 2018 – October 2018. Respondents were asked about demographic characteristics, health insurance status, referral status, health care facility factors and answer the Personal Satisfaction Questionnaire 18 (PSQ 18) survey. Results: The questionnaire survey included 251 patients. The total rate bypassing of local health care facilities was 37.8%. Pearson chi square test revealed that educational attainment was associated with increased bypass of health care facilities (p=0.013). Factors such as age, sex, civil status, employment status, monthly income and health insurance status were significantly associated with bypass. Availability of medical doctors was the most prevelant factor in choosing a health care facility in both bypassers (36%) and non bypassers (46%). PSQ 18 survey revealed that patients are generally satisfied on the availment of health services in both bypassers (mean 3.78) and non bypassers (mean 3.89). The subscales in communication, time spent with doctor and accessibility and convenience were scored highest while technical quality was scored lowest on both groups. Conclusion Bypass of local health care facilities is a major health concern. Travelling longer distances for health care imposes unnecessary shift of direct health care costs into indirect costs such as transport. Increasing awareness of available local health care facilities and services together with its improvement might help decrease bypass especially on patients with lower educational attainment. The referral system and network of health care providers should be reinforced for better health care service delivery, patient satisfaction and lower health care cost.
Referral and Consultation ; Surveys and Questionnaires

Objective: To decrease the total time spent of new patients on a General Clinic consult at the Department of Ophthalmology and Visual Sciences of a Philippine Tertiary Hospital. Methods: A time quality management team was formed. The description of the process of a General Clinic new patient consult was elucidated and was consolidated in a data collection form. Convenience sampling of the population was done. The collection and analysis of the data were done with institution of interventions to address the factors causing the prolonged consultation visit; then, pre-intervention analysis, post-intervention analysis and comparison were done. Results: Thirty-five new patients were tracked prior to and after intervention. Among the identified causes for prolonged new patient consult were delay in temporary chart, front of chart and blue card issuance, insufficient examination tools and resident dedicated to the General Clinic, unnecessary examination and patient not being around when called. Most causes were addressed. A mean decrease of 68±112 minutes or approximately 18% in total time stay was noted. Conclusion This study showed that the total consultation time of a new patient in General Clinic decreased. This was achieved with the help of most of the personnel involved in the system after identifying factors causing the prolonged consultation visit and instituting interventions to address these identified factors. The improvement in health service delivery was taken as a step by step process. A preliminary step was demonstrated in this paper for future interventions for better service delivery.
Ophthalmology ; Outpatients ; Referral and Consultation