The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger

Background  

For a health district to function referral from health centres to district hospitals is critical. In many developing countries referral systems perform well below expectations. Niger is not an exception in this matter. Beyond obvious problems of cost and access this study shows to what extent the behaviour of the health worker in its interaction with the patient can be a barrier of its own.     

Collective violence and attitudes of women toward intimate partner violence: Evidence from the Niger Delta

Background  

The Niger Delta region of Nigeria has been undergoing collective violence for over 25 years, which has constituted a major public health problem. The objectives of this study were to investigate the predictors of women's attitudes toward intimate partner violence in the Niger Delta in comparison to that of women in other parts of Nigeria.     

A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality

Background  

Generic community mental health teams (CMHTs) currently deliver specialist mental health care in England. Policy dictates that CMHTs focus on those patients with greatest need but it has proved difficult to establish consistent referral criteria. The aim of this study was to explore the referral process from the perspectives of both the referrers and the CMHTs.     

The effects of the Two-Week Rule on NHS colorectal cancer diagnostic services: A systematic literature review

Background  

The Two-Week Rule (TWR) was introduced to ensure that all patients with a suspected colorectal cancer (CRC) saw a hospital specialist within 14 days of an urgent GP referral. Guidelines were available to GPs to facilitate the appropriate TWR referral of patients exhibiting high-risk CRC symptoms.     

Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study

Background  

To understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted.     

Comparison of different strategies of referral to a fall clinic: How to achieve an optimal casemix?

Objective  

To study the potential differences in patient characteristics between two referral methods to a fall clinic, specifically: case-finding of patients admitted to an emergency department because of a fall, compared to direct referral to the fall clinic via the general practitioner.     

Effectiveness of maternal referral system in a rural setting: a case study from Rufiji district,Tanzania

Background  

The functional referral system is important in backing-up antenatal, labour and delivery, and postnatal services in the primary level of care facilities. The aim of this study was to evaluate the effectiveness of the maternal referral system through determining proportion of women reaching the hospitals after referral advice, appropriateness of the referral indications, reasons for non-compliance and to find out if compliance to referrals makes a difference in the perinatal outcome.     

Bridging the care continuum: patient information needs for specialist referrals

Background  

Information transfer is critical in the primary care to specialist referral process and has been examined extensively in the US and other countries, yet there has been little attention to the patient's perspective of the information transfer process. This cross-sectional study examined the quality of the information received by patients with a chronic condition from the referring and specialist physician in the specialist referral process and the relationship of the quality of information received to trust in the physicians.     

Criteria-based audit to improve a district referral system in Malawi: A pilot study

Background  

To study the feasibility of using criteria-based audit to improve a district referral system.     

Community referral in home management of malaria in western Uganda: A case series study

Background  

Home Based Management of fever (HBM) was introduced as a national policy in Uganda to increase access to prompt presumptive treatment of malaria. Pre-packed Chloroquine/Fansidar combination is distributed free of charge to febrile children <5 years. Persisting fever or danger signs are referred to the health centre. We assessed overall referral rate, causes of referral, referral completion and reasons for non-completion under the HBM strategy.     

Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design

Background  

The National Institute of Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the utility of a Self Determination Theory (SDT)-based exercise referral consultation.     

Referral patterns of children with poor growth in primary health care

Background  

To promote early diagnosis and treatment of short stature, consensus meetings were held in the mid nineteen nineties in the Netherlands and the UK. This resulted in guidelines for referral. In this study we evaluate the referral pattern of short stature in primary health care using these guidelines, comparing it with cut-off values mentioned by the WHO.     

Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

Background  

Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments might be too brief for the hospital to initiate these programmes. Therefore, it was relevant to evaluate a new clinical practice which combined the general practitioner's (GP) referral to surgery with a referral to a smoking and alcohol intervention in the surgical pathway.     

A Bayesian network approach to the study of historical epidemiological databases: modelling meningitis outbreaks in the Niger

Objective

To develop a tool for evaluating the risk that an outbreak of meningitis will occur in a particular district of the Niger after outbreaks have been reported in other, specified districts of the country.

Methods

A Bayesian network was represented by a graph composed of 38 nodes (one for each district in the Niger) connected by arrows. In the graph, each node directly influenced each of the “child” nodes that lay at the ends of the arrows arising from that node, according to conditional probabilities. The probabilities between “influencing” and “influenced” districts were estimated by analysis of databases that held weekly records of meningitis outbreaks in the Niger between 1986 and 2005. For each week of interest, each district was given a Boolean-variable score of 1 (if meningitis incidence in the district reached an epidemic threshold in that week) or 0.

Findings

The Bayesian network approach provided important and original information, allowing the identification of the districts that influence meningitis risk in other districts (and the districts that are influenced by any particular district) and the evaluation of the level of influence between each pair of districts.

Conclusion

Bayesian networks offer a promising approach to understanding the dynamics of epidemics, estimating the risk of outbreaks in particular areas and allowing control interventions to be targeted at high-risk areas.     

Use of Bayesian geostatistical prediction to estimate local variations in Schistosoma haematobium infection in western Africa

Objective

To predict the subnational spatial variation in the number of people infected with Schistosoma haematobium in Burkina Faso, Mali and the Niger prior to national control programmes.

Methods

We used field survey data sets covering a contiguous area 2750 × 850 km and including 26 790 school-age children (5–14 years old) in 418 schools. The prevalence of high- and low-intensity infection and associated 95% credible intervals (CrIs) were predicted using Bayesian geostatistical models. The number infected was determined from the predicted prevalence and the number of school-age children in each km².

Findings

The predicted number of school-age children with a low-intensity infection was 433 268 in Burkina Faso, 872 328 in Mali and 580 286 in the Niger. The number with a high-intensity infection was 416 009, 511 845 and 254 150 in each country, respectively. The 95% CrIs were wide: e.g. the mean number of boys aged 10–14 years infected in Mali was 140 200 (95% CrI: 6200–512 100).

Conclusion

National aggregate estimates of infection mask important local variations: e.g. most S. haematobium infections in the Niger occur in the Niger River valley. High-intensity infection was strongly clustered in western and central Mali, north-eastern and north‑western Burkina Faso and the Niger River valley in the Niger. Populations in these foci will carry the bulk of the urinary schistosomiasis burden and should be prioritized for schistosomiasis control. Uncertainties in the predicted prevalence and the numbers infected should be acknowledged by control programme planners.     

The importance of examining movements within the US health care system: sequential logit modeling

Background  

Utilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements.     

Two years of psychogeriatric consultations in a nursing home: reasons for referral compared to psychiatrists' assessment

Background  

In spite of the high prevalence of psychiatric disorders among elderly residents in nursing homes, only a small number of patients in need of specialist care are referred to a psychiatric consultant. The aim of this research was to evaluate the consultation activity and the appropriateness of referral to psychiatric assessment.     

The effect of linking community health centers to a state-level smoker's quitline on rates of cessation assistance

Background  

Smoking cessation quitlines are an effective yet largely untapped resource for clinician referrals. The aim of this study was to assess the effect of a fax referral system that links community health centers (CHCs) with the New York State Quitline on rates of provider cessation assistance.     

Exploring ethical considerations for the use of biological and physiological markers in population-based surveys in less developed countries

Background  

The health information needs of developing countries increasingly include population-based estimates determined by biological and physiological measures. Collection of data on these biomarkers requires careful reassessment of ethical standards and procedures related to issues of safety, informed consent, reporting, and referral policies. This paper reviews the survey practices of health examination surveys that have been conducted in developed nations and discusses their application to similar types of surveys proposed for developing countries.