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Exact(6)
There is also a continuing worry about the range of referral rates which raises the concern of both over- and under-use of secondary care [ 13].
Future research should focus on exploring the effectiveness of quality improvement measures and include strategies to both reduce the level and range of referral rates.
The wide range of referral rates between GPs has been well documented, but our reported seven-fold increase is among the highest ever reported [ 2, 11].
The present research surveyed clinicians working in six Westernized countries with the aims: a) to establish the range of referral pathways, b) to evaluate the typical treatment options for categories of subjective tinnitus defined as acute or chronic, and c) to seek clinical opinion about levels of satisfaction with current standards of practice.
There was a significant reduction in the variability of referral ratios and conversion, detection and emergency presentation rates, with a notably larger reduction in the interquartile range of referral ratios for 'activity' practices compared with those not taking up any specified activity (Table 3).
Age ⩾60 years (pooled PLR: 2.79, 95% confidence interval (CI) 2.00 3.90), weight loss (pooled PLR: 1.89, 95% CI: 1.03 3.07) and change in bowel habit (pooled PLR: 1.92, 95% CI: 0.54 3.57) raise the probability of colorectal cancer into the range of referral to secondary care but do not conclusively 'rule in' the diagnosis.
Similar(53)
However, as referrals and comfort levels increased over time, the SMH chiropractors have seen a wider range of referrals and increasingly have been asked to provide 'second opinion' level service when their physicians are unsure of the diagnosis (ie, because of diagnostic uncertainty, they will defer the diagnostic opinion to the chiropractors).
The introduction of financial subsidies for some allied health care gave GPs a broader range of affordable referral choices outside the public sector, which they preferred to use.
The range of reported referral options were standardised into seven categories to enable direct comparison between the groups (See Table 1).
The effect of varying the pass/fail criterion for UVA measured at the vision screening on PPV and NPV was examined by calculating odds ratios (ORs) for a range of acuity referral criteria, which enabled the drawing of a receiver operating characteristic curve.
It was anticipated that collectively, participants would have a range of experiences of referral.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com