Background Patients referred to specialised mental health care are usually triaged based on refer... more Background Patients referred to specialised mental health care are usually triaged based on referral information provided by general practitioners. However, knowledge about this system’s ability to ensure timely access to and equity in specialised mental health care is limited. We aimed to investigate to the degree to which patient triage, based on referral letter information, corresponds to triage based on a hospital specialist’s consultation with the patient, and whether the degree of correspondence is affected by the quality of the referral letter. Methods We gathered information from three specialised mental health centres in Norway regarding patients that were referred and offered health care (N = 264). Data consisted of triage decisions for each patient (i.e., the hospital specialist’s assessment of maximum acceptable waiting time), which were determined on the basis of a) referral information and b) meeting the patient. Referral letter quality was evaluated using the Quality ...
OBJECTIVE To investigate how GPs use the PSA test as a diagnostic tool in daily practice. DESIGN ... more OBJECTIVE To investigate how GPs use the PSA test as a diagnostic tool in daily practice. DESIGN Qualitative study using focus group interviews, the transcripts being analyzed by systemic text condensation. SUBJECTS A total of 17 Norwegian GPs in three CME groups. MAIN OUTCOME MEASURES Exploring GPs' attitudes to national guidelines and the practical use of the PSA test. RESULTS Detecting prostate cancer in general practice is a common and important, but difficult diagnostic issue. Our participants experienced uncertainty regarding the test when to use it, how to interpret the results and when to refer to specialist health services. CONCLUSION The study revealed a general ambivalence to the use of PSA. Many patients present urological problems, and many are afraid of having cancer. PSA is commonly used, but sometimes generates problems rather than solving them. IMPLICATIONS The use of the PSA test should be based on a thorough clinical assessment and in close collaboration with the patient.Key pointsMany patients in general practice present urological problems, and many are afraid of having cancer.GPs have a general ambivalence to the use of PSA when to use it, how to interpret the results and when to refer to specialist health services.The use of PSA sometimes generates problems rather than solving them.
Questions about the referral process to hospital for non-urgent patients. Appendix 2. Referral re... more Questions about the referral process to hospital for non-urgent patients. Appendix 2. Referral registration form. (DOCX 16 kb)
Communication between involved parties is essential to ensure coordinated and safe health care de... more Communication between involved parties is essential to ensure coordinated and safe health care delivery. However, existing literature reveals that the information relayed in the referral process is seen as insufficient by the receivers. It is unknown how this insufficiency affects the quality of care, and valid performance measures to explore it are lacking. The aim of the present study was to develop quality indicators to detect the impact that the quality of referral letters from primary care to specialised mental health care has on the quality of mental health services. Using a modified version of the RAND/UCLA appropriateness method, a systematic literature review and focus group interviews were conducted to define quality indicators for mental health care expected to be affected by the quality of referral information. Focus group participants included psychiatrists, psychologists, general practitioners, patient representatives and managers. The existing evidence and suggested i...
Introduction Several studies have indicated that medical referral letters do not convey the neces... more Introduction Several studies have indicated that medical referral letters do not convey the necessary information to ensure sufficient coordination of care. However, there is no definition of the core set of information items that should be communicated in a referral process, and no valid measurements to assess, and thus improve, the quality of such information. The present study aimed to develop and test an instrument to measure the quality of referral information provided by general practitioners to specialised mental health care services for adults. Methods Based on a recommendation taking the users’ standpoint into account, a minimum set of items for referral communication seen as essential by experienced specialists ( N = 42) was developed. An instrument to assess the quality of referral information for specialised mental health care for adults was then examined based on its psychometric properties. The examination was conducted within the region of Western Norway Regional Heal...
Within the health system, communication between the different levels of care is essential for the... more Within the health system, communication between the different levels of care is essential for the patients' clinical pathways and medical treatment. This includes the referral process: how and why patients are sent from the primary care level to specialist health services. We wanted to identify and describe hospital consultants' reflections on and attitudes to the referral process and cooperation with general practitioners (GPs). A qualitative study of semi-structured interviews with 13 hospital consultants representing eight different specialties, analyzed using systematic text condensation. Interviews conducted from February 2011 to October 2012. The consultants reported a considerable workload assessing referrals from GPs and prioritizing patients for specialist services. National guidelines were used as well as individual standards and guidelines. Good referrals could make the prioritization process easier. The specialists expressed a deep concern about securing a fair p...
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 23, 2006
Is it useful for patients in general practice to have a copy of their medical record, and will th... more Is it useful for patients in general practice to have a copy of their medical record, and will this increase the quality of the record? What do patients and their doctors think about such a practice? Eight general practitioners participated in a study where they should ask their patients if they wanted at copy of their medical record after the consultation. The doctors were asked about what they felt about such a practice. 181 patients participated. 126 patients (70%) wanted to read their medical record. Among these, 118 (94%) reported that the record covered the problem they came for, 104 (83%) that it was useful to read what the doctor had written, and 96 (76%) that this practice should be more common. The doctors answered that the records became somewhat changed and longer and were more time-consuming. Most of the doctors thought that the quality of the medical record improved and that the procedure could well be standardised. The results indicate that many patients in general pr...
Background Patients referred to specialised mental health care are usually triaged based on refer... more Background Patients referred to specialised mental health care are usually triaged based on referral information provided by general practitioners. However, knowledge about this system’s ability to ensure timely access to and equity in specialised mental health care is limited. We aimed to investigate to the degree to which patient triage, based on referral letter information, corresponds to triage based on a hospital specialist’s consultation with the patient, and whether the degree of correspondence is affected by the quality of the referral letter. Methods We gathered information from three specialised mental health centres in Norway regarding patients that were referred and offered health care (N = 264). Data consisted of triage decisions for each patient (i.e., the hospital specialist’s assessment of maximum acceptable waiting time), which were determined on the basis of a) referral information and b) meeting the patient. Referral letter quality was evaluated using the Quality ...
OBJECTIVE To investigate how GPs use the PSA test as a diagnostic tool in daily practice. DESIGN ... more OBJECTIVE To investigate how GPs use the PSA test as a diagnostic tool in daily practice. DESIGN Qualitative study using focus group interviews, the transcripts being analyzed by systemic text condensation. SUBJECTS A total of 17 Norwegian GPs in three CME groups. MAIN OUTCOME MEASURES Exploring GPs' attitudes to national guidelines and the practical use of the PSA test. RESULTS Detecting prostate cancer in general practice is a common and important, but difficult diagnostic issue. Our participants experienced uncertainty regarding the test when to use it, how to interpret the results and when to refer to specialist health services. CONCLUSION The study revealed a general ambivalence to the use of PSA. Many patients present urological problems, and many are afraid of having cancer. PSA is commonly used, but sometimes generates problems rather than solving them. IMPLICATIONS The use of the PSA test should be based on a thorough clinical assessment and in close collaboration with the patient.Key pointsMany patients in general practice present urological problems, and many are afraid of having cancer.GPs have a general ambivalence to the use of PSA when to use it, how to interpret the results and when to refer to specialist health services.The use of PSA sometimes generates problems rather than solving them.
Questions about the referral process to hospital for non-urgent patients. Appendix 2. Referral re... more Questions about the referral process to hospital for non-urgent patients. Appendix 2. Referral registration form. (DOCX 16 kb)
Communication between involved parties is essential to ensure coordinated and safe health care de... more Communication between involved parties is essential to ensure coordinated and safe health care delivery. However, existing literature reveals that the information relayed in the referral process is seen as insufficient by the receivers. It is unknown how this insufficiency affects the quality of care, and valid performance measures to explore it are lacking. The aim of the present study was to develop quality indicators to detect the impact that the quality of referral letters from primary care to specialised mental health care has on the quality of mental health services. Using a modified version of the RAND/UCLA appropriateness method, a systematic literature review and focus group interviews were conducted to define quality indicators for mental health care expected to be affected by the quality of referral information. Focus group participants included psychiatrists, psychologists, general practitioners, patient representatives and managers. The existing evidence and suggested i...
Introduction Several studies have indicated that medical referral letters do not convey the neces... more Introduction Several studies have indicated that medical referral letters do not convey the necessary information to ensure sufficient coordination of care. However, there is no definition of the core set of information items that should be communicated in a referral process, and no valid measurements to assess, and thus improve, the quality of such information. The present study aimed to develop and test an instrument to measure the quality of referral information provided by general practitioners to specialised mental health care services for adults. Methods Based on a recommendation taking the users’ standpoint into account, a minimum set of items for referral communication seen as essential by experienced specialists ( N = 42) was developed. An instrument to assess the quality of referral information for specialised mental health care for adults was then examined based on its psychometric properties. The examination was conducted within the region of Western Norway Regional Heal...
Within the health system, communication between the different levels of care is essential for the... more Within the health system, communication between the different levels of care is essential for the patients' clinical pathways and medical treatment. This includes the referral process: how and why patients are sent from the primary care level to specialist health services. We wanted to identify and describe hospital consultants' reflections on and attitudes to the referral process and cooperation with general practitioners (GPs). A qualitative study of semi-structured interviews with 13 hospital consultants representing eight different specialties, analyzed using systematic text condensation. Interviews conducted from February 2011 to October 2012. The consultants reported a considerable workload assessing referrals from GPs and prioritizing patients for specialist services. National guidelines were used as well as individual standards and guidelines. Good referrals could make the prioritization process easier. The specialists expressed a deep concern about securing a fair p...
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 23, 2006
Is it useful for patients in general practice to have a copy of their medical record, and will th... more Is it useful for patients in general practice to have a copy of their medical record, and will this increase the quality of the record? What do patients and their doctors think about such a practice? Eight general practitioners participated in a study where they should ask their patients if they wanted at copy of their medical record after the consultation. The doctors were asked about what they felt about such a practice. 181 patients participated. 126 patients (70%) wanted to read their medical record. Among these, 118 (94%) reported that the record covered the problem they came for, 104 (83%) that it was useful to read what the doctor had written, and 96 (76%) that this practice should be more common. The doctors answered that the records became somewhat changed and longer and were more time-consuming. Most of the doctors thought that the quality of the medical record improved and that the procedure could well be standardised. The results indicate that many patients in general pr...
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Papers by Olav Thorsen