School of Medicine, University of Sunderland, Sunderland, UK.
BMJ Open. 2019 Jul 9;9(7):e028436. doi: 10.1136/bmjopen-2018-028436.
Exploring the views of stakeholders to the referral management systems (RMS) used by GP practices in Northumberland, UK to evaluate its perceived effectiveness.
This was an in-depth qualitative semi-structured interview study.
32 participants (GPs, hospital consultants, referral support, hospital managers, Clinical Commissioning Group manager) in the North East of England, UK.
Interviews using a grounded theory approach and thematic analysis.
The main benefit of RMS mentioned by participants was that it allowed for unnecessary referrals to be vetted by consultants, and helps ensure patients are sent to the correct clinic. Generally, the consultants in our study felt that RMS did not significantly help them reject referrals. Some GPs experienced that RMS undermined GP autonomy and did not help when they had exhausted their abilities to manage a patient in primary care, and it was suggested that in some cases RMS may delay rather than prevent a referral. The main perceived disadvantage of RMS was the additional workload for GPs and consultants, and RMS was felt to be a barrier to commutation between GPs and consultants. Frustration with the system design and lack of knowledge of its cost-effectiveness were articulated.
Although RMS was reported to reduce some unnecessary referrals, the effect of referral delay and rejection is unknown. Although there were some positive attributes described, RMS was mostly received negatively by the stakeholders.
探讨利益相关者对英国诺森伯兰郡 GP 诊所使用的转诊管理系统（RMS）的看法，以评估其感知效果。
这是一项深入的定性半结构化访谈研究。
英国东北部的 32 名参与者（全科医生、医院顾问、转诊支持人员、医院管理人员、临床委托组经理）。
使用扎根理论方法和主题分析进行访谈。
参与者提到的 RMS 的主要好处是，它允许顾问对不必要的转诊进行审查，并有助于确保患者被送到正确的诊所。总的来说，我们研究中的顾问认为 RMS 并没有显著帮助他们拒绝转诊。一些全科医生认为 RMS 损害了全科医生的自主权，并且在他们已经用尽了在初级保健中管理患者的能力时，也没有帮助，有人建议在某些情况下，RMS 可能会延迟而不是阻止转诊。RMS 的主要被认为的缺点是增加了全科医生和顾问的工作量，并且被认为是全科医生和顾问之间交流的障碍。对系统设计的不满和对其成本效益的缺乏了解都被表达了出来。
尽管 RMS 被报道可以减少一些不必要的转诊，但转诊延迟和拒绝的影响尚不清楚。尽管描述了一些积极的属性，但 RMS 主要还是被利益相关者负面评价。
