Gilbert Liu, a pediatrician and associate professor at the University of Louisville, recently completed a 20-month pilot park-prescription program of his own and a concurrent study to determine if park referrals changed patients' behavior.
Respondents also stated that guidelines helped them advocate for clients or services, encouraged client centred or multidisciplinary care, helped to prioritise referrals, changed practice, supported the development of policies and practices, and helped improve goal setting.
Outcome measures included follow-up, referral, changes to antihypertensive drug treatment, and BP control (normotensive reading, BP < 140/90 mmHg, and whether subsequent recorded measures were also in the normal range - sustained normotension).
Overall referral rate changed insignificantly (from 38%to35%5%; p=0.19).
In addition, in the context of telephone referral, we changed the 'R' from 'Recommendation' to 'Request' as we were teaching students who would usually be requesting advice from more senior colleagues.
The authority said the counting of referrals had changed over the years with the implementation of the Department of Health's No Secrets guidance and new counting conventions.
Data from the UK also suggest that cancer referral guidelines do not appear to have changed referral practice in Britain or outcomes for cancer patients [ 10].
At this threshold level, the self-referral change has a probability of being cost-effective of 0.57.
Further research is therefore required to examine if and how the extent and nature of GP referrals change with specific attempts by individual CCNTs to develop referral pathways.
The self-referral change is both more effective (+0.011 QALYs) and more costly (+£127), which results in an ICER of £11,378 per additional QALY, when compared to current care.
