Online Referrals Research Articles

Provider perspectives on maternal care challenges for Black and Latine Women in Indiana: a qualitative interview study

Indiana consistently ranks among the states with the highest maternal and infant mortality in the United States, particularly affecting Black and Latine communities, endangering their right to safe and respectful maternal care. Providers working with these communities are crucial in identifying challenges faced by their clients, and to inform programmes and policies. We interviewed 32 clinical and community-based providers to understand their perspectives on the challenges faced by their Black and Latine clients from February to April 2021. Participants were identified through online sources and referrals. Interviews, conducted over online video, were recorded, transcribed, and analysed following a six-step thematic approach. Six areas of challenges emerged: non-medical infrastructure and policy problems, effects of systemic racism and bias, insecurity of the Latine community, dissatisfaction with maternal care delivery, issues in navigating maternal healthcare, and limitations to holistic models of care. The results demonstrate the interconnected structural, organisational, and interpersonal nature of the challenges. Though challenges were described at structural and organisational levels, the focus of state maternal care programs is largely at personal and interpersonal levels. Obstetric racism, citizenship restrictions, shortage of Black and Latine providers, and transportation issues are complex problems, requiring multilevel interventions and policies to ensure Black and Latine women can exercise their right to safe and respectful maternal care. A rights-based approach centring the needs of Black, Latine and other minoritised communities should be implemented to make effective changes with an equity focus.

Contribution of Online Referral Systems to Health Services: Systematic Review

The online referral system (eReferral) is designed to improve waiting times and efficiency by standardizing information and online communication in the referral process. Online referral is the automation of the referral process in which appointments and other information regarding the outcome of a consultation are transferred between two or more healthcare providers. This study was designed to identify the implementation of online referrals at various levels of health care. This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of the 10 articles included in this review, 6 studies were conducted in the USA, 2 studies in Canada, and one each in the UK, and Saudi Arabia. The studies used a variety of designs, including Quasi-experimental (n=5), longitudinal (n=2), qualitative (n=1), and Research and Development (n=2). This study provides a clear picture of the use of an online referral system, starting from the work process, effectiveness, barriers, and development possibilities for a wider reach. This system is very helpful in easing the workload of specialist doctors and for patients who are referred users get the benefit of shorter waiting times/queues, making it possible to reduce medical costs further.

Contribution of Online Referral Systems to Health Services: Systematic Review

The online referral system (eReferral) is designed to improve waiting times and efficiency by standardizing information and online communication in the referral process. Online referral is the automation of the referral process in which appointments and other information regarding the outcome of a consultation are transferred between two or more healthcare providers. This study was designed to identify the implementation of online referrals at various levels of health care. This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of the 10 articles included in this review, 6 studies were conducted in the USA, 2 studies in Canada, and one each in the UK, and Saudi Arabia. The studies used a variety of designs, including Quasi-experimental (n=5), longitudinal (n=2), qualitative (n=1), and Research and Development (n=2). This study provides a clear picture of the use of an online referral system, starting from the work process, effectiveness, barriers, and development possibilities for a wider reach. This system is very helpful in easing the workload of specialist doctors and for patients who are referred users get the benefit of shorter waiting times/queues, making it possible to reduce medical costs further.

Facilitating Access to Mental Health Services: A Stakeholder-Driven Improvement of the Children and Young People (CYP) as One Referral Platform.

(1) Background: Pre-pandemic, child and adolescent mental health service (CAMHS) referrals were paper based in Liverpool and Sefton (England, United Kingdom), causing delays in waiting times. The "CYP as One" online mental health referral platform was co-created to overcome these challenges. (2) Methods: This study aims to improve "CYP as One" accessibility and usability and, subsequently, support CAMHS to improve waiting times. The current study utilised the Living Lab approach. We conducted content analysis on completed online referrals extracted from the "CYP as One" platform. These findings were supplemented by seven online focus groups, with 16-19-year-old young people, parents of children under 16, and health service providers. Thematic analysis was conducted on all data. (3) Results: The thematic analysis returned seven themes, namely (i) "CYP as One" vs. Traditional Referrals, (ii) Gender and Language Dynamics, (iii) Digital Empathy in Action, (iv) the Influence of the Provider Perspective, (v) Age and Social Sensitivity, (vi) Enhancing Access to Information, and (vii) Boosting Admin and Clinical Efficiency. (4) Conclusions: Digital content that seeks to replace in-person referrals can provide adequate support to children and young people who have faced difficulties accessing mental health services.

Study of Digital Marketing in Tourism and Hospitality Industry: A Literature Search Using the Keyword Co-Occurrence Mapping Network

Digital marketing is essential to the travel and hospitality industries. These days, it's a helpful tool for creating digital brand names and attracting and retaining clients. It has been demonstrated that using digital technology to implement marketing strategies, such as influencer marketing, social media marketing, and search engine optimization, benefits businesses. Through the process of monitoring customer behavior and assessing their preferences, digital marketing allows businesses to offer personalized and engaging content that encourages online referrals. Digital technology must be included into a number of sectors, including operations, services, communications, revenue management, distribution, and marketing, for the industry to be stimulated and reinvigorated. Hotel businesses need to reevaluate their current economic models and embrace digital marketing as an essential tool if they are to expand. The aim of the current research is to search the keywords in the database dimensions and creating co-occurrence mapping using VOSviewer software. Finally, the importance of digital marketing in tourism and hospitality industry is researched using research database and presented using term co-occurrence mappings.

Utilization of Online Referral for National Health Insurance Patient Services in Indonesia: A Scoping Review

The evolution of the outpatient referral system for BPJSK participants has transitioned from a manual-based system to an online-based approach. The present discourse examines the use of online referrals in patient care under NHI programme in Indonesia. The literature search conducted in this systematic review adheres to the PRISMA methodology and utilises the Google Scholar and PubMed databases. Using online referral in the context of NHI patients is a topic of interest. A total of six papers underwent a systematic evaluation. The assessment of the utilization of online referrals was conducted by evaluating patient satisfaction and the effectiveness of NHI project. The satisfaction of NHI patients concerning time certainty, referral certainty, waiting time, service access, service quality, service process, and service system is influenced by the utilization of online referrals. The practicality of the online referral strategy can be assessed through its impact on programme understanding, targeting precision, goal achievement, and tangible changes. The urgency of online referrals could be more persuasive. In order to enhance the efficiency of waiting time, it is imperative to implement supportive measures, such as the utilization of online queues and streamlining the process of online referrals in primary healthcare settings and hospitals

PD12 An audit of the photodynamic therapy service at the Birmingham Skin Centre

Abstract Photodynamic therapy (PDT) is licensed in the UK for treating at least one nonmelanoma skin cancer and premalignant lesions. The PDT is a service offered at our centre but is anecdotally underutilized with no up-to-date outcome measures. The aim was to audit the PDT service at the Birmingham Skin Centre against the 2018 British Association of Dermatologists and British Photodermatology Group PDT guidelines, and make recommendations for improvement. Retrospective data were gathered on consecutive patients treated with topical PDT between 12 March 2019 and 28 August 2022 at the Birmingham Skin Centre and compared with the recommended audit points in the national guidelines. A clinician survey was conducted to assess service awareness, satisfaction and referral process. Thirty-four patients received topical PDT during the specified time period; two patients were excluded from data analysis as the last treatment fell within the 3-month assessment period (n = 32). Differentiation between ambulatory and standard PDT was not recorded. Treatment was licensed in all cases (n = 32): actinic keratosis (AK; n = 18), squamous cell carcinoma (SCC; n = 7) in situ, superficial basal cell carcinoma (BCC; n = 4), nodular BCC (n = 1) and other (n = 2). Clearance assessment at 3 months was recorded in 21 of 32 cases; accounting for this, the clearance rate for AK, SCC in situ and superficial BCC at 3 months after last treatment was 52% (n = 11/21; guideline recommendation ≥ 75%). Eleven of 32 patients treated for SCC in situ and superficial BCC within the data set were due 12-month clearance assessment. Four of 11 patients had clearance assessment recorded. Accounting for this, the clearance rate for SCC in situ and superficial BCC at 12 months after last treatment was 50% (n = 2/4; guideline recommendation ≥ 75%). No patient had an individual pain-management plan documented. Patient satisfaction of the service was recorded in 9% (n = 3/32) of cases; of these, 67% (n = 2/3) of patients were ‘very satisfied’ and 33% ‘satisfied’. Patient satisfaction of cosmetic result was recorded in one case as ‘excellent’. The PDT was a popular treatment method among the clinicians surveyed. Some clinicians asked for PDT-based teaching. The general consensus supported online referrals and documentation. The PDT is used for licensed indications and popular with clinicians in our department. Clearance rates at 3 (52%) and 12 (50%) months are below the national guideline recommendation of 75%. Limited documentation across audit points limits interpretation of clearance rates, patient satisfaction and adverse effects. We plan to implement a new standardized digital referral and documentation system to improve the service.

P96. EXPANDING BURN EXPERTISE THROUGH TELEMEDICINE FOR THE FRONTLINERS DURING THE COVID-19 PANDEMIC

PURPOSE: Inexperience of frontliners in burn wound assessment results to unnecessary COVID-19 exposures during this pandemic. This study determined the accuracy and timeliness in diagnosing and classifying burn patients assessed by a frontliner non-burn specialist in-person (NBSP), a Burn Specialist online (BSO), and a Burn Specialist in-person (BSP). METHODS: All burn patients (January to March 2021) with signed consents for participation were photographed in a standardized manner by the NBSP and referred to a BSO via Telegram™. These patients were also assessed independently by the BSP. The % total body surface area (TBSA), burn depth classification, and the timestamps (seen by the NBSP, online referrals sent to the BSO, BSO sent the diagnoses, and assessment by the BSP) were recorded. One-Way Repeated Measures Analysis of Variance (ANOVA) with and without blocking were done. RESULTS: Data gathered from 82 patients throughout the study demonstrated that burn size (% TBSA) among the three different physicians (NBSP, BSO, BSP) was not statistically significant (p=0.8794). Our analysis showed no statistical difference for the 19 different body parts per patient and burn depth classification (p=0.9718). One-way ANOVA tests on timeliness were statistically significant with p<0.0001. Post-hoc comparison using Tukey test revealed no statistical significance between the BSO and BSP (p=0.892). CONCLUSION: Frontliners can refer to burn specialists using smartphone telemedicine platform for optimum burn care with an accurate diagnosis during and even after this pandemic. Timeliness can be improved with a dedicated 24/7 online available burn specialists and a reliable network access.

582 Expanding Burn Expertise Through Telemedicine for the Frontliners during the COVID-19 Pandemic

IntroductionInexperience of frontliners and referring physicians from non-specialty centers in burn wound assessment results to the incorrect triage of patients, thereby aggravating the current hospital situations and causing unnecessary exposures. Emergency care in burn centers in developing countries must strike a balance between doctor and patient safety, and uncompromised care of burn patients. Telemedicine is deemed a valid and sound option to maintain social distancing and promote safety, yet provide proper burn care. It is a valuable and indispensable tool for all doctors of all branches of medicine and surgery. Although many of its limitations in developing countries are still being unraveled, the benefits of this technology are being realized worldwide. This study determined the accuracy and timeliness in diagnosing and classifying burn patients assessed by a frontliner non-burn specialist in-person (NBSP), a Burn Specialist online (BSO), and a Burn Specialist in-person (BSP).MethodsAll burn patients (January to March 2021) with signed consent for participation were photographed in a standardized manner by the NBSP and referred to a BSO via an online messaging application. These patients were also assessed independently by the BSP. The % total body surface area (TBSA), burn depth classification, and the time the patients were seen by the NBSP, the time the online referrals were sent to the BSO through the messaging application, the time the BSO sent the diagnoses, and the time of assessment by the BSP, were recorded. One-Way Repeated Measures Analysis of Variance (ANOVA) with and without blocking were done.Post-hoc Tukey-Test was used to analyze the pair-wise differences for any ANOVA that showed significant statistical differences.ResultsData gathered from 82 patients throughout the 3-month study duration demonstrated that burn size (% TBSA) among the three different physicians (NBSP, BSO, BSP) was not statistically significant (p=0.8794). Our analysis also showed no statistical difference for the 19 different body parts per patient and burn depth classification (p=0.9718). One-way ANOVA tests on timeliness were statistically significant with a p-value of p< 0.0001. A post-hoc comparison using Tukey test revealed no statistical significance between the BSO and BSP (p=0.892).ConclusionsSmartphone telemedicine platform through photographic transfer and analysis is an accurate method in estimating burn size and depth classification. Timeliness can be improved with a dedicated 24/7 online available burn specialists and a reliable network access. Hence, frontliners can refer to burn specialists in a developing country using this telemedicine platform for optimum burn care with an accurate diagnosis and overcome the challenges during and even after this pandemic.

MRI provision for patients with cardiac implantable electronic devices: understanding the real-world administrative requirements of service delivery

Abstract Introduction Patients with cardiac implantable electronic devices (CIEDs) should have access to Magnetic Resonance Imaging (MRI) but are less likely to be referred and hospitals lack provision. A major barrier to service delivery is the administrative demand required to obtain accurate CIED details prior to scheduling. We aimed to understand the administrative requirements of a high-volume Cardiac Device-MRI service to inform the design of an electronic referrals platform that can facilitate workflow. Methods Single centre retrospective audit of a high-volume Cardiac Device-MRI service in a tertiary unit in the UK. Six months of referrals were reviewed for patient and CIED details and barriers met. Referrals were stratified by source, indication, MR-Conditional labelling and referrer. Results Administrative barriers were reviewed for 116 patients with CIEDs referred for MRI (48% cardiac, 52% non-cardiac) between September 2020 and March 2021 (Table 1). Referrers were 47% cardiologists and 53% other specialties. Referral to scan time was 15 days (interquartile range, 8–32). There were no scan-related complications. 34% of referrals contained complete CIED details and 30% stated the MR labelling of the CIED. None incorrectly labelled a CIED as MR-Conditional, but 8% incorrectly labelled as non-MR Conditional. 7 additional days were required to obtain complete CIED details where not provided (involving information requests from two device clinics in 27%), 10% had delays over 2 weeks (maximum 145 days). 35% required 3 or more repeat discussions with referrers after initial referral. Obtaining CIED information for external referrals required 17 days (11–42), compared to 14 (6–35) days for internal referrals (p=0.25). Patients with non-MR Conditional CIEDs required on average 14 days longer to obtain complete referral details than patients with MR-Conditional CIEDs. Even when referrers were aware of non-MR Conditional labelling and received information on risk, 41% required further discussion between patient and referrer regarding risks and benefits of MRI scanning. For cancer referrals, obtaining correct details took 1 day longer than other referrals (p=0.074) and required 2 extra emails to maintain provision within the national time-to-treatment target of 62 days. Missing data was similarly present in referrals from Cardiologists and non-Cardiologists (59% versus 61% respectively), but non-Cardiologists recorded more incorrect CIED details (8% vs 0%). Conclusions Referral for MRI in patients with CIEDs demands significant administrative input to obtain correct device information, leading to delays. These delays are greater for patients with non-MR conditional CIEDs, and data provided is often incorrect or incomplete. This may explain why some patients are not referred for MRI. An online referrals platform has been developed to streamline this process, initially deployed through a network of 60 centres registered in the UK. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work is supported by British Heart Foundation Innovations funding (HFHF_016).

Using social media and direct marketing as a platform to increase awareness of lung cancer screening in a Hispanic urban population in the post-COVID period.

339 Background: Uptake in lung cancer screening (LCS) in high-risk patients including minority populations has been low despite efforts to increase awareness in the community. During the COVID pandemic, most LCS programs were temporarily stopped and, in the months to follow experienced a significant reduction in referrals. Platforms including social media and direct mail marketing can provide a valuable tool to enhance patient engagement related to LCS and engagement of Hispanic populations who are active consumers of digital media. The objective of this study was to assess the short-term effectiveness of a targeted LCS digital and direct marketing campaign to increase visits to the institutional online educational content and referrals to a LCS program. Methods: A LCS marketing campaign including social media utilizing Facebook and Instagram platforms with programmatic banners, boosted organic social media posts, plus direct mail-in marketing in Spanish and English was started in the post-COVID period. A CRM (customer-relationship management) software was used to target adults ages 50-80, current or former smokers, who speak English and/or Spanish in the Miami tri-county area over a three-month period by a direct-mail campaign. Other campaign targeting qualifications included family history of lung cancer, and additional lung cancer risk factors including asbestos, chronic obstructive pulmonary disease, or emphysema. The CRM Direct mail campaign was sent 87,000 leads by postcard and 65,810 leads by email. Primary outcomes measures were visits to the University of Miami institutional LCS Web page, LDCT ambulatory referrals, and scheduled initial LDCT exams. Study period was baseline pre-COVID period (6/1/2019-12/31/2019), COVID-period (3/1/2020-9/31/2020) and digital awareness campaign in the post-COVID period (12/1/2020-5/31/2020). Results: Unique pageviews to the institutional LCS web pages were significantly higher during the digital awareness campaign compared to the pre-COVID period (8,805 vs 230 pageviews) with a high bounce rate during the campaign period of 79% and average time in site of 2:21 minutes. Mean scheduled initial LDCT volumes per month during the pre-COVID period were 12.4 (SD 4.6), versus 4.1 (SD 2.5) during the COVID period. There was a 3-fold increase in initial LDCT scans during the initial campaign period from 4.1 in the COVID period to 11.6 (p &lt;.001). The mean number of LDCT ambulatory referrals doubled from 17.5 in the COVID period to 34.2 in the campaign period (p &lt; 0.001). Conclusions: Implementation of a targeted LCS digital awareness campaign and direct mail marketing was associated with increased visits to institutional education Web pages, ambulatory referrals, and initial LDCT exams. Digital platforms are an important tool to enhance awareness of lung cancer screening in high-risk populations and Hispanics.

Recommendations are Golden – Referral Marketing via Influencers for Arts and Cultural Organizations / Recommendations are Golden – Empfehlungsmarketing über Influencer für Kunst- und Kultureinrichtungen

Prof. Dr. Schwarz, Mrs. Hein, and Dr. Cramer von Clausbruch analyze how the digital transformation is influencing the marketing communication measures used by arts and cultural organizations. Media use has shifted towards the online sphere; simultaneously overstimulation of the senses by advertisements provokes insecurities regarding product choice. As a consequence, consumers often base purchase decisions on online referrals. This essay applies the findings of relevant literature on influencer marketing to arts and cultural institutions. Influencer marketing can reduce uncertainties and aids customers in reaching decisions. Strategies, opportunities and risks are outlined to provide an overview of the marketing strategy.

Introducing a single point of access (SPA) to child and adolescent mental health services in England: a mixed-methods observational study

BackgroundIn many high-income countries, primary care practitioners are the main point of referral for specialist mental health services. In England, Child and Adolescent Mental Health Services (CAMHS) are increasingly adopting a Single Point of Access (SPA) to streamline referrals and introduce self and parent/carer-referrals. This involves a significant shift of responsibility from primary care towards CAMHS who adopt a more active role as gatekeeper for their service. This study evaluates the adoption of a SPA in CAMHS across a large region in England.MethodsWe conducted an observational mixed methods study in two CAMHS from January 2018 to March 2019 to evaluate the adoption of a SPA. We collected quantitative data from electronic patient records and qualitative data through ethnographic observation and in-depth interviews of staff and stakeholders with experience of using CAMHS. Additional data on volumes was shared directly from the SPAs and a further snapshot of 1 week’s users was collected.ResultsA similar SPA model emerged across the two services. Staff were positive about what the model could achieve and access rates grew quickly following awareness-raising activities. Despite the initial focus being on a telephone line, online referrals became the more regularly used referral method. Increased access brought challenges in terms of resourcing, including identifying the right staff for the role of call handlers. A further challenge was to impose consistency on triage decisions, which required structured information collection during the assessment process. Similar to GP referrals, those self-referring via the SPA were mainly from the least deprived areas.ConclusionsThe introduction of a SPA has the potential to improve young people’s access to mental health services. By addressing some of the barriers to access, simplifying where to go to get help and making it easier to contact the service directly, a SPA can help more individuals and families access timely support. However, the introduction of a SPA does not in itself expand the capacity of CAMHS, and therefore expectations within services and across sectors need to be tempered accordingly. SPA services providing different referral approaches can further improve access for the harder to reach populations.

Analysis of The Implementation of Online Referral for National Health Security Participant At PKU Muhammadiyah Karanganyar Hospital

This research is kualitatif with the approach of case studies. This research was conducted in April-August 2019 at PKU Muhammadiyah Karanganyar Hospital, with in-depth interviews and observations related to implementation, obstacles, supporting factors, and policies related to online referrals. The results of the study showed the compatibility between the results of the implementation in the field compared with existing regulations. Implementation has met the needs of human resources and infrastructure, the flow stage is in accordance with Permenkes number 01 of 2012, obstacles that arise due to the delegation of focused authority, supporting factors, namely good coordination between units, and policies on SOP regarding full referral which do not regulate in detail about implementing online referrals. Recommendations based on this research, it is hoped that an evaluation of the implementation of the National Health Insurance policy on online referrals at PKU Muhammadiyah Karanganyar Hospital and improve services will be better

EFEKTIVITAS RUJUKAN ONLINE BAGI PASIEN RAWAT JALAN DALAM PROGRAM JAMINAN KESEHATAN NASIONAL (JKN) DI KOTA SOLOK

This study aims to determine the effectiveness of online referrals for outpatients in the National Health Insurance Program (JKN) in the city of Solok and describe the constraints and efforts that realize the effectiveness of online referrals for outpatients in the city of Solok. This research is motivated by the obstacles in FKTP as well as complaints from participants or the community when the online referral system was implemented. This research uses a qualitative method with a descriptive approach. The instrument of data collection was through interviews, observations and documentation. The results of this study were the effectiveness of online referrals in the national health insurance program in the city of Solok. It was not effective because there were still some obstacles, both constraints from BPJS, FKTP, FKRTL and also complaints felt by the participants.

Geographical Pattern of Online Word-of-Mouth: How Offline Environment Influences Online Sharing

We study the geographical pattern of online word-of-mouth (WOM). Specifically, we examine whether and how customers' local environment influences the generation and direction of online WOM. Leveraging a unique research design, we measure the online WOM at a U.S. national e-commerce platform by tracking the WOM referral decisions of customers in over 240,000 purchases. In parallel, we measure the local environment of customers by combining a range of proprietary and public data sources (Facebook, Census, ESRI, and SCCBS). This includes the offline social environment (e.g., friend visiting frequency, neighbor interactions, and population mobility), online social environment (e.g., Facebook ties), and local historical sales across geographical areas. We build a stylized theoretical framework based on customer sharing motives and social networks to guide our empirical examination. While digital technologies have enabled customers to share without physical boundaries, we find that location still plays significant roles in the generation and direction of online WOM. First, a customer's offline social environment significantly explains the generation of online referrals (whereas local characteristics known to drive online sales do not positively explain the referral generation). Second, online referrals are largely bounded locally (e.g., 47% within 10 miles), and referrals in areas with more local social interactions are more likely to stay local. Third, even when referrals travel far, they are more likely to point at destinations socially similar to the origins. Our findings have important implications for firms in allocating resources across geographical areas as well as using referral directions as signals to identify high-potential geographical markets.

Social Prescribing and Integrated Care: An Evaluability Assessment

Background: In the United Kingdom UK there is a desperate need to fund the National Health Service NHS to better reflect the populace at a local level. In response, the NHS Five Year Forward View [1] was published and noted that a “one size fits all” model of care was no longer practical. As part of delivering this remit, new models of care have been designed to deliver more integrated care and create partnerships at the community level.[1] One such model is the Encompass multispecialty community provider MCP; one of 14 ‘vanguards’ established across the UK in response to improving the integration of health and social care [2] whilst also looking towards non-clinical resolutions. This necessity to pursue a more inclusive and sustainable approach to health has allowed concepts such as social prescribing to rise to prominence. Method: An evaluability assessment EA was undertaken to determine if there was enough evidence to carry out a full evaluation of the social prescribing service Red Zebra in relation to the MCP remit. The EA included collaboration with end users, elaboration, testing and refinement of an agreed programme theory, understanding the programme reality, identification and review of existing data sources and making assessments against key criteria.[3], [4] The key criteria considered were: Quality of project purpose Quality of expected outputs Availability of baseline and monitoring data Feasibility of attribution Data Collection: In-person interviews were undertaken with social prescribing managers, case officers and commissioners engaged with the Encompass MCP process. To address the key criteria the research team also collated and analysed information related to Red Zebra’s history, aims, objectives, staff job descriptions, copies of client feedback forms and the social prescribing platform they utilise to undertake their work known as Connect Well CW.The CW database documents online referrals and whether the activity provider has responded to the referral. Self-referrals are recorded independently by the organization. Additionally, as this system is not compliant with NHS information governance NHS patient numbers are not recorded and therefore cannot be linked with other patient activity. Conclusion: Data showed, service users being predominantly older people with long-term conditions requiring support for social isolation. At the time of this assessment, impact of the service was not possible to evaluate as there was not a formal assessment of either patient reported outcomes or change in health service use. While satisfaction with onward referral providers is assessed via feedback forms, these do not include questions on users’ experience of Red Zebra. Whilst promising, the outcome data collected by Red Zebra at this juncture needed to have included a formal assessment of client perceived benefits and anticipated outcomes of the service itself to be considered for a full evaluation.

Does social couponing stimulate positive eWOM and online referrals?

Purpose of the paper : Social couponing campaigns are becoming increasingly popular among hotels. However, while their short-term impacts have been assessed, their medium and long-term benefits for the hotels’ reputation have not been measured yet. The purpose of this study is to provide evidence of the potential of social couponing to stimulate positive electronic word ‐ of ‐ mouth (eWOM) and online referrals to hotels. In addition, this research intends to identify the factors related to the design and management of the couponing campaign, which influence the couponers’ willingness to engage in positive eWOM and referrals. Methodology : The study is based on the content analysis of 564 TripAdvisor reviews posted by guests that have stayed at 76 Italian hotels using a Groupon’s coupon. Both frequency and co-occurrence analysis are performed. Findings : The results show that social couponing stimulates intense positive eWOM and referrals. The analysis also highlights the most important coupon-related factors, which are able to influence the valence (positive vs. negative) of the eWOM. Research limits : The small sample of hotels, considered in this research and the specific features of the Italian hotel industry suggest caution in generalizing the results to other settings. Practical Implications : Hotel managers should design and manage their couponing campaigns carefully considering several factors, identified by this study, which directly stimulate positive eWOM. The findings of this research also suggest that hotel managers could use couponing campaigns as effective tools for their online reputation management strategies. Originality of the paper : This paper provides empirical evidence of the eWOM and referral effects of social couponing. Hence, it complements previous studies, which have mostly considered the short-term effects of social couponing related to sales increase.

Online Referrals Categorization and Performance of the Hospitality Industry: The Case of International Hotel Brands in Europe

1.IntroductionTechnological enhancements, especially the internet and mobile devices have been reshaping the world and marketing as well. Today, all communication directions in terms of business (B2B, B2C, C2C, C2B) possible within the virtual environment. Digital media is a new avenue to retain existing customers and acquire new customers for marketers. Numerous business fields have been affected by technological changes and the tourism industry as well. Tourism is highly affected by these developments since tourists have a high tendency of using digital platforms and tourism is an information-intensive industry (Poon, 1993; Sheldon, 1997). Tourists' purchases and the whole information search behavior being digitalized. As Schueckert, Liu and Law (2015: 608) stated that 71% of independent tourists make their hotel bookings online. These figures demonstrated that virtual channels dominate the tourism distribution system. Although tourists make their hotel bookings offline, they may use the internet for gathering information about hospitality establishments. Gretzel and Yoo (2008: 39) have found out that 96.4% of the frequent internet users consult online tourists' reviews while they planning their trips. Also, another research showed that 49% of potential tourists won't make their hotel reservations without reading online tourist reviews (Statisticbrain, 2014). Thus, keeping up with new media has become indispensable for hospitality managements.People today can be defined as cyber citizens because they spend more and more of their time in digital environments. As Wertime and Fenwick (2008) stated, the boundaries of physical and virtual begin to blur. Also, markets begin to digitalize in parallel with the digitalization of the human lives. Therefore, marketers have to focus on virtual markets in addition to physical markets. In other words, companies competing with them both in the physical and virtual markets. There is a huge potential in the virtual world for marketers and if they omit this to target this market, they will pay a heavy price for such their unsuccessful strategies. In this context, there is an old statement where the fish are which may guide marketers.This research simply broadens the understanding of online reviews in hospitality. The aim of this research is to evaluate current online marketing performance of international hotel brands in Europe by adopting a holistic approach. As Wang and Tang (2003: 14) highlighted that further empirical research and theoretical development necessary for understanding online marketing better. Also, Cantallops and Salvo (2014) have published a literature review article which classified the researches under two categories as review-generating and impact of e-wom. It can be observed that the subjects like how frequently consumers use digital sources, to what extend they affected, why they share information in these environments and similar - broadly investigated in the literature. Although researchers have focused on the subject in terms of demand-side in their researches, it is possible to say that they don't pay enough attention to the supply-side. This research may be thought to be important due to its contribution on the supply-related side of the subject. This paper is composed of six parts. In the theoretical review part, conceptual aspect of the subject is explained and a review of literature is given. The proposed model of classification of online referrals is presented in part three. In the fourth part, selected European hotel chains' use of online marketing in a certain point of time is provided. The fifth part provides the results followed by concluding remarks.2.Literature Review2.1.Online ReviewsIt is known that the internet is one of the digital areas affected by rapid changes. Web 2.0 or social media technology is a milestone in the history of internet's development. There is no need to discuss how web 2. …

Effects of suspicion on the perception of online referrals: the role of congruity and message sidedness

This research investigates how a consumer's suspicion that an online referral may result from marketers' involvement affects referral persuasiveness. Two referral characteristics are examined in this regard: referral congruity and message sidedness. It is demonstrated that referral congruity can motivate consumers to question the authenticity of online referrals and that message sidedness determines subsequently the type of motive attributed to observed referral behaviour. It is further shown that the perceived referral motive affects attitudes toward the recommended item as well as purchase intentions. Based on the findings implications are drawn for planning effective referral campaigns.