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

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 Heal...

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Autores principales: Blundell, N, Clarke, A, Mays, N
Formato: Texto
Lenguaje:English
Publicado: BMJ Group 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989159/
https://www.ncbi.nlm.nih.gov/pubmed/20534715
http://dx.doi.org/10.1136/qshc.2007.025684
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author Blundell, N
Clarke, A
Mays, N
author_facet Blundell, N
Clarke, A
Mays, N
author_sort Blundell, N
collection PubMed
description 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). 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. 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. 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.
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spelling pubmed-29891592010-12-17 Interpretations of referral appropriateness by senior health managers in five PCT areas in England: a qualitative investigation Blundell, N Clarke, A Mays, N Qual Saf Health Care Original Research 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). 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. 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. 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. BMJ Group 2010-06-09 2010-06 /pmc/articles/PMC2989159/ /pubmed/20534715 http://dx.doi.org/10.1136/qshc.2007.025684 Text en © 2010, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
spellingShingle Original Research
Blundell, N
Clarke, A
Mays, N
Interpretations of referral appropriateness by senior health managers in five PCT areas in England: a qualitative investigation
title Interpretations of referral appropriateness by senior health managers in five PCT areas in England: a qualitative investigation
title_full Interpretations of referral appropriateness by senior health managers in five PCT areas in England: a qualitative investigation
title_fullStr Interpretations of referral appropriateness by senior health managers in five PCT areas in England: a qualitative investigation
title_full_unstemmed Interpretations of referral appropriateness by senior health managers in five PCT areas in England: a qualitative investigation
title_short Interpretations of referral appropriateness by senior health managers in five PCT areas in England: a qualitative investigation
title_sort interpretations of referral appropriateness by senior health managers in five pct areas in england: a qualitative investigation
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989159/
https://www.ncbi.nlm.nih.gov/pubmed/20534715
http://dx.doi.org/10.1136/qshc.2007.025684
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