Evans Elizabeth, Aiking Harry, Edwards Adrian
Aneurin Bevan Health Board, Pontypool, Gwent, UK.
Qual Prim Care. 2011;19(4):263-72.
General practitioner (GP) referral rates to hospital services vary widely, without clearly identified explanatory factors, introducing important quality and patient safety issues. Referrals are rising everywhere year on year; some of these may be more appropriately redirected to lower technology services.
To use peer review with consultant engagement to influence GPs to improve the quality and effectiveness of their referrals.
Service development project.
Ten out of 13 GP practices in Torfaen, Gwent; consultants from seven specialties in Gwent Healthcare NHS Trust; project designed and managed within Torfaen Local Health Board between 2008 and 2009.
GPs discussed the appropriateness of referrals in selected specialties, including referral information and compatibility with local guidelines, usually on a weekly basis and were provided with regular feedback of 'benchmarked' referral rates. Six-weekly 'cluster groups', involving GPs, hospital specialists and community health practitioners discussed referral pathways and appropriate management in community based services.
Overall there was a reduction in variation in individual GP referral rates (from 2.6-7.7 to 3.0-6.5 per 1000 patients per quarter) and a related reduction in overall referral rate (from 5.5 to 4.3 per 1000 patients per quarter). Both reductions appeared sustainable whilst the intervention continued, and referral rates rose in keeping with local trends once the intervention finished.
This intervention appeared acceptable to GPs because of its emphasis on reviewing appropriateness and quality of referrals and was effective and sustainable while the investment in resources continued. Consultant involvement in discussions appeared important. The intervention's cost-effectiveness requires evaluation for consideration of future referral management strategies.
全科医生（GP）向医院服务机构的转诊率差异很大，且没有明确的解释因素，这引发了重要的质量和患者安全问题。各地的转诊率逐年上升；其中一些转诊可能更适合转向技术要求较低的服务。
通过与顾问参与的同行评审来影响全科医生，以提高其转诊的质量和有效性。
服务开发项目。
格温特郡托尔芬的13家全科医疗诊所中的10家；格温特郡国民保健服务信托基金7个专科的顾问；该项目于2008年至2009年在托尔芬地方卫生局内设计和管理。
全科医生讨论选定专科转诊的适宜性，包括转诊信息以及与当地指南的兼容性，通常每周进行一次，并获得“基准”转诊率的定期反馈。每六周举行一次“分组会议”，全科医生、医院专科医生和社区健康从业者参与讨论转诊途径以及社区服务中的适当管理。
总体而言，全科医生个人转诊率的差异有所降低（从每季度每1000名患者2.6 - 7.7例降至3.0 - 6.5例），总体转诊率也相应降低（从每季度每1000名患者5.5例降至4.3例）。在干预持续期间，这两种降低似乎都是可持续的，并且干预结束后转诊率随当地趋势上升。
由于该干预措施强调审查转诊的适宜性和质量，全科医生似乎能够接受，并且在持续投入资源的情况下是有效且可持续的。顾问参与讨论似乎很重要。该干预措施的成本效益需要评估，以便考虑未来的转诊管理策略。
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