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We also performed a multivariate analysis of variance (MANOVA) for three intended outcome measures (TLFB, YSR, and CBCL) together, to examine the extent to which referral source accounted for site differences when considering variables combined.
To contribute to this research and to understand further the point in the care pathway at which inequalities arise, we undertook a national study to examine the extent to which referral for defined symptoms from primary care varied according to patients' age, sex, and socioeconomic circumstances.
Objectives To determine the extent to which referral for defined symptoms from primary care varies by age, sex, and social deprivation and whether any sociodemographic variations in referral differ according to the presence of national referral guidance and the potential of the symptoms to be life threatening.
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All patients had well-controlled hypertension and diabetes, mild anemia (hemoglobin level of 11.5 mg/dL), and a GFR equal to 20 ml/min/1.73 m, a level of renal function at which referral to the nephrologist is recommended [ 3].
To examine which referral pathways were associated with GHS service levels, participant usage data from July 2010 to June 2011 was examined.
Guidelines do not specify which motivational strategies to use, which PN procedures to follow, or which referral strategy is preferred and how exactly to implement it.
[Female no.4, early 50s, Region 1] Health care professionals also stated that current guidelines do not specify in detail which motivational strategies to use, which PN procedure to follow, or which referral strategy is preferred; the guidelines only include a recommended recall period for tracing back sex partners.
Discussion on operational aspects of the study will be included, such as the way in which referral rates to physiotherapy will be monitored regularly so that adequate additional support can be provided, if needed.
The major limitation of our study is that the data were taken from a single referral centre, to which all referrals were voluntary.
As such, the extent to which subsequent referral practice could be influenced by participation (the 'dose effect') will have varied between practices.
Socio-economic variations in the utilization of specialist services seem to be well-established in health systems in which referrals to specialists are made by primary physicians who play an important role in follow-up visits and hospital admissions.
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