General Practice Referrals Research Articles

The selection of patients for breast reduction: should health commissions have a say?

Selective or restrictive access policies operate for breast reduction, despite proven benefits. The rationale for these policies, in particular the requirement of psychiatric assessment prior to a plastic surgical consultation, as an aid to patient selection by the health commission, was examined in 57 general practice referrals to a plastic surgical unit. In 22 cases, these policies deterred the patient or GP from pursuing the referral further. Sixteen cases were funded by the health commission directly, 16 patients required psychiatric or orthopaedic referrals, and three patients were refused funding outright. The decision to fund, reject or refer to a non-plastic-surgical specialist was not statistically related to the patients’ symptoms. Non-plastic-surgical assessment resulted in referral for a plastic surgical opinion in 15 of 16 patients. We conclude that these selective policies are unsatisfactory, since patient management is not related to symptoms and the use of non-plastic-surgical opinions by the health commission as an aid to rationing is of little benefit.

Genital tract infections in women attending for colposcopy

SummarySummaryWe present the results of a retrospective audit on genital tract infections among women attending a colposcopy clinic. The frequency of infections among general practice referrals was high at 31.5% with bacterial vaginosis and undiagnosed genital warts being the commonest diagnoses. Our results suggest that any physician taking a sinear or performing colposcopy should be aware of the high rate of concomitant infection.

An analysis of general practice referral behaviour to psychiatric out-patient clinics

AbstractObjective: The objective of this study was to analyse general practice referrals to psychiatric out-patient clinics and their relation to practice and patient variables.Method: Retrospective analysis of new episode attendances at out-patient services over a three year period was undertaken. Referring practices were examined for referral rates, single or group practice and the presence of Vocational/Psychiatric training within the practice.Results: Referral rates were similar to national rates, but were lower than other jurisdictions. There was a tendency for group practices to have lower referral rates.Conclusions: There was considerable difference between practices in referral rates. These differences were significantly related to GP vocational training.

Do clinical guidelines improve general practice management and referral of infertile couples?

To evaluate guidelines for general practice management and referral of infertile couples. Guidelines were implemented with a disease specific reminder at the time of consultation (the guidelines were embedded within a structured infertility management sheet for each couple). Pragmatic randomised controlled trial. Participating practices were randomised to a group that received the guidelines and a control group. 82 general practices in Grampian region. 100 couples referred by general practitioners receiving the guideline and 100 couples referred by control general practitioners. Whether the general practitioner had taken a full sexual history and examined and investigated both partners appropriately. Characteristics of patients referred by study and control general practitioners did not differ significantly at baseline. Compliance with the guidelines increased for all targeted activities. General practitioners in the study group were more likely to take a sexual history (for example, couples' use of fertile period, 85% v 69%, p < 0.01); examine both partners (female partner, 68% v 52%, p < 0.05; male partner 39% v 13%, p < 0.01); and investigate both partners (day 21 progesterone, 72% v 41%, p < 0.001; semen analysis, 51% v 41%, p > 0.05). Improvements were greater when general practitioners used the disease specific reminder. Receiving guidelines led to improvements in the process of care of infertile couples within general practice. This effect was enhanced when the guidelines were embedded in a structured infertility management sheet for each couple.

The PQRSTUV: The Personal Questionnaire Rapid Scaling Technique –‘Ultimate Version’

A variation of procedure is described which greatly reduces the time required to administer Mulhall's PQRST. It lessens the sensitivity of the scale but retains other features. It uses the same materials as PQRST with some minor clerical alterations and, like the PQRST, takes less time to construct than Shapiro's original PQ. It has been used routinely with general practice and psychiatry out-patient referrals and is likely to have clinical rather than research application.

Total abdominal and pelvic ultrasound: incidental findings and a comparison between outpatient and general practice referrals in 1000 cases

We read with interest the article by Dr Mills and colleagues (November, 1989) reporting incidental findings during abdominal and pelvic ultrasound in 1000 cases. The authors encountered nine cases with extrapelvic abnormality in 55 patients with pelvic pain (16%) and 14 patients with pelvic abnormality in patients referred for examination of the upper abdomen. Our experience in the use of ultrasound in assisted conception confirms their observations; we have reported a case where acute hydrothorax was the only manifestation of ovarian hyperstimulation syndrome (Kingsland et al, 1989), which demonstrates the discrepancy between the site of pathology and the presentation.

Total abdominal and pelvic ultrasound: incidental findings and a comparison between outpatient and general practice referrals in 1000 cases

It is undoubtedly true that transvaginal scanning gives high resolution images of pelvic structures and is widely used in infertility treatment regimes. In fact this was not available in our unit at the time the study was performed so that question did not arise. Nevertheless, we would hesitate to recommend immediate recourse to transvaginal scanning in patients, many of whom are elderly, who have a possible pelvic abnormality found when being scanned for extrapelvic symptoms. The four patients who had false positive initial scans were correctly diagnosed after simply repeating the scan with a full bladder.