Over the study period the source of patient referral changed.
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.
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.
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.
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.
Sensitivity analysis was also undertaken in order to check the impact of referral rate changes on model results.
Often, the referral pattern changes with the availability of a new therapy; over time, more advanced and often also less advanced cases are included for therapy.
Overall referral rate changed insignificantly (from 38%to35%5%; p=0.19).
Cleary et al (2007) study was conducted before 2005 and the introduction of guidance from National Institute for Health and Care Excellence (NICE), which recommended urgent referral for change in bowel habit, diarrhoea, rectal bleeding and anaemia (National Institute for Health and Care Excellence, 2005).
