Referral system

Referral System role in Family Medicine.

1. Referral system

2. Referral system Referral System , involves sending a patient to another physician for ongoing management of specific problem , with the exception that the patient will continue to see the original physician for coordination of total care. Definition

3. Also defined as… a process in which the P.H.C physician who has lesser facilities to manage clinical condition seeks the assistance of specialist partner with resources to guide in managing clinical episode.

4. NB. Referral does not mean transferring responsibility. But, it’s S haring responsibility in patient care.

5. When to refer ? When the family physician need specified investigation or advice. When the family physician is dissatisfied with the patient's progress or unsure of the diagnosis. When the patient or his family shows doubt or lack confidence in the of diagnosis or management. Medical-legal concerns by the physician, the patient or both .

6. Factors affecting referrals ? a. Availability of qualified consultants. b. Physician specialty. c. Length of training . d. Unexplained findings. e. Uncertainty of diagnosis f. Patient characteristics. g. Reimbursement plan Factors Affecting Referrals..

7. The decision is made. Consideration is given to the patient's medical, emotional, cultural and socioeconomic background. Selection of appropriate specialty and appropriate physician in the field. Preparation for both the patient and the family for consultation. Preparation of the consultant. Referral Process 6. The consultant provides feedback to the family physician. 7. The family physician evaluates the appropriateness of the consultant's recommendation. 8.The family physician facilitates the patient and the family's acceptance of recommendation. 9. The family physician acts on the recommendations or selects another consultant in the same or different field. 10. The family physician provides feedback to the consultant regarding the outcome

8. STEPS OF THE REFERRAL PROCESS: 1. Establish a good relationship with the patient. 2 . Establish the need for a referral. 3 . Set objectives for the referral. 4 . Explore resources availability. 5 . Patient decides to use or not use. 6 . Make pre-referral treatment. 7 . Facilitate, coordinate referral. 8 . Evaluate and follow up. Steps of Referral Process

9. Benefits of referral: For the patient - Prompt diagnosis and management - Save time, money and effort. - Better outcome For the family physician - learning and training - Gaining self confidence. - Increase communication between the health care staff For the Consultant - Improve the quality of the patient's management. - Increase communication between the health care staff Benefits of Referral

10. Patient details ( name, location, age and sex ). Details of family physician(name of physician making request and Name physician being consulted ) Reasons for referral. Degree of urgency for appointment . Clinical problem. Important Previous history. Findings on physical examination. Findings on investigation(photocopies of results should be included ) . Medication and drug sensitivities. E xpected outcome and desirable fpllow up. Referral letter outline

11. Types of Referral

12. Types of Referral

13. It can be classified according to the case to:

14. Modern Classification Patient with MI admitted in hospital for a period of then return for continuity of time As in diabetic patient with glaucoma referral to ophthalmologist Self - Referral Multi-specialty in the same center.

15. 4 Levels of Referral

16. Disadvantages of Self Referral and Direct access to hospital

17. Basic Principle of Referral It should be..

18. So, it’s not an end, but just a beginning! is just a beginning of a process which would continue by following the patient in the hospital by visits or telephone discussion and on discharge he must be followed through home visits. The hospitals should establish an office for collecting and sending feed back to the referring physician (two-way referral) Referral System

19. Thank You!