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Implications of offering patient choice for routine adult surgical referrals

Project final report

  • Document type:
    Research report
  • Author:
    Taylor Roger, Pringle Mike, Coupland Carol. Commissioned from Dr Foster and University of Nottingham by Department of Health
  • Published date:
    7 April 2004
  • Primary audience:
    Professionals
  • Gateway reference:
    3098
  • Pages:
    61
  • Copyright holder:
    Joint

This study was designed and commissioned to assess the feasibility of offering choice of referral pathway in general practice consultations to patients needing routine referral for surgery.

Executive summary

This study was designed as a randomised controlled trial, clustered by general practice, followed by a descriptive trial of sustainability.  It was undertaken in three Strategic Health Authorities areas in England: Trent; Norfolk, Suffolk and Cambridgeshire; and Dorset and Somerset. 116 general practitioners in 38 general practices were recruited. 75 were randomised to the intervention arm and 75 to the control; with 593 patients recruited, 309 in the intervention arm, 215 in the control arm, and 69 in the sustainability follow on phase.

The study involved patients requiring routine referral for surgery being asked for informed consent to take part in the study. Those in intervention practices were then offered an information booklet concerning local hospitals and had their choices explained to them. If they wanted to take time in making a choice, they were encouraged to do so, using a 24-hour a day telephone helpline or special website if necessary.

The main findings are:

  • Only 22% of the participating doctors reported offering choice 'all' or 'most' of the time before the study.
  • 65% of the general practitioners had positive attitudes towards offering choice of hospital to patients when referring.
  • Implementing choice extended mean consultation length in consultations involving a referral by 36 seconds (not statistically significant).
  • The increase in delayed referral, while the patient considered the options, rose from 1% to 14% and will have administrative implications.
  • Patients experiencing choice of referral location reported that they were the person making the choice of hospital on 81% of cases, compared to 37% of the controls.
  • Patients considered ease of access and quality of care as more important than waiting times in making their choice.
  • No effect on the referral pathways was shown, with most patients still opting for their local hospital.
  • We conclude that of offering choice is feasible and would be welcomed by general practitioners and patients.

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