An intervention to improve the adequacy of referrals from primary care to a department of urology

This study analyses the effect of two interventions implemented in order to improve adherence to the terms of a protocol for referring patients from primary care to a urology department. A telephone counselling line for professionals was implemented, and joint training sessions were held (twice, at six-month intervals). The terms "appropriate" and "inappropriate" were used to identify referrals complying with the locally developed protocol and those that did not, respectively. Referral appropriateness at baseline (T0) was compared with that six months after the first (T1) and second (T2) meeting. Linear trend analysis was used to test for trends in adequacy across the study. Appropriateness of 6,088 consecutive referrals was analysed. At T0, 58% of the referrals (2810/4841) were judged to be "appropriate". Adequacy improved significantly at T1 (70.6% vs. 58% at T0; chi2 < 0.001). At T2, 75.4% of the referrals met the terms of the protocol; the difference between results at T1 and T2 was not statistically significant (chi2 = 0.06). Overall (T0 vs. T2), a 17.4% improvement was confirmed (chi2 < 0.001). A trend toward more appropriate referrals was detected over time (Mantel-Haenszel test for linear trend, z = 9.62; p < 0.001). As the use of communication resources was anecdotal, mathematical analysis of its effect on adequacy could not be performed. Training activities are worthwhile for improving referral adequacy. Stable rates over time are possible. Using communication resources may be unnecessary if accessibility is guaranteed.