Trial reportBMC family practice2006
Implementing referral guidelines: lessons from a negative outcome cluster randomised factorial trial in general practice.
Trial report in BMC family practice, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Pooled it
- Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Pooled it
- Referral interventions from primary to specialist care: a systematic review of international evidence.The British journal of general practice : the journal of the Royal College of General Practitioners · 2014Pooled it
- Interventions to reduce primary care delay in cancer referral: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2011Pooled it
- Electronic clinical decision support tool for assessing stomach symptoms in primary care (ECASS): a feasibility study.BMJ open · 2021Trial
- The effect of referral templates on out-patient quality of care in a hospital setting: a cluster randomized controlled trial.BMC health services research · 2017Trial
- Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial.BMC health services research · 2015Trial
- Impact of referral letters on scheduling of hospital appointments: a randomised control trial.The British journal of general practice : the journal of the Royal College of General Practitioners · 2014Trial
- Trial
- Trial
- Educational Interventions to Reduce Cancer Diagnostic Delays in Primary Care: A Scoping Review.Journal of cancer education : the official journal of the American Association for Cancer Education · 2026Review
- Adoption, acceptance, and use of a decision support tool to promote timely investigations for cancer in primary care.Family practice · 2024Article
- Optimization of a Quality Improvement Tool for Cancer Diagnosis in Primary Care: Qualitative Study.JMIR formative research · 2022Article
- Article
- A categorisation of problems and solutions to improve patient referrals from primary to specialty care.BMC health services research · 2018Review
- Protocol-Driven Decision Support within e-Referral Systems to Streamline Patient Consultation, Triaging and Referrals from Primary Care to Specialist Clinics.Journal of medical systems · 2017Article
- The role of primary care in early detection and follow-up of cancer.Nature reviews. Clinical oncology · 2014Review
- Impact of a referral management "gateway" on the quality of referral letters; a retrospective time series cross sectional review.BMC health services research · 2013Article
- The quality of communication about older patients between hospital physicians and general practitioners: a panel study assessment.BMC health services research · 2007Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFew patients with lower bowel symptoms who consult their general practitioner need a specialist opinion. However data from referred patients suggest that those who are referred would benefit from detailed assessment before referral.
methodsA cluster randomised factorial trial. 44 general practices in North Trent, UK. Practices were offered either an electronic interactive referral pro forma, an educational outreach visit by a local colorectal surgeon, both or neither. The main outcome measure was the proportion of cases with severe diverticular disease, cancer or precancerous lesions and inflammatory bowel disease in those referred by each group. A secondary outcome was a referral letter quality score. Semi-structured interviews were conducted to identify key themes relating to the use of the software
resultsFrom 150 invitations, 44 practices were recruited with a total list size of 265,707. There were 716 consecutive referrals recorded over a six-month period, for which a diagnosis was available for 514. In the combined software arms 14% (37/261) had significant pathology, compared with 19% (49/253) in the non-software arms, relative risk 0.73 (95% CI: 0.46 to 1.15). In the combined educational outreach arms 15% (38/258) had significant pathology compared with 19% (48/256) in the non-educational arms, relative risk 0.79 (95% CI: 0.50 to 1.24). Pro forma practices documented better assessment of patients at referral.
conclusionThere was a lack of evidence that either intervention increased the proportion of patients with organic pathology among those referred. The interactive software did improve the amount of information relayed in referral letters although we were unable to confirm if this made a significant difference to patients or their health care providers. The potential value of either intervention may have been diminished by their limited uptake within the context of a cluster randomised clinical trial. A number of lessons were learned in this trial of novel innovations.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.