title: Referral interventions from primary to specialist care: a systematic review of international evidence.
abstract: BACKGROUND
  Demand management defines any method used to monitor, direct, or regulate patient referrals. Strategies have been developed to manage the referral of patients to secondary care, with interventions that target primary care, specialist services, or infrastructure.
  
  
  OBJECTIVE
  To review the international evidence on interventions to manage referral from primary to specialist care.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Iterative, systematic searches of published and unpublished sources public health, health management, management, and grey literature databases from health care and other industries were undertaken to identify recent, relevant studies. A narrative synthesis of the data was completed to structure the evidence into groups of similar interventions.
  
  
  RESULTS
  The searches generated 8327 unique results, of which 140 studies were included. Interventions were grouped into four intervention categories: GP education (n = 50); process change (n = 49); system change (n = 38); and patient-focused (n = 3). It is clear that there is no 'magic bullet' to managing demand for secondary care services: although some groups of interventions may have greater potential for development, given the existing evidence that they can be effective in specific contexts.
  
  
  CONCLUSIONS
  To tackle demand management of primary care services, the focus cannot be on primary care alone; a whole-systems approach is needed because the introduction of interventions in primary care is often just the starting point of the referral process. In addition, more research is needed to develop and evaluate interventions that acknowledge the role of the patient in the referral decision.
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Blank
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield.
authors.forename: Susan
authors.initials: S
authors.lastname: Baxter
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield.
authors.forename: Helen Buckley
authors.initials: HB
authors.lastname: Woods
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Goyder
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lee
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield.
authors.forename: Nick
authors.initials: N
authors.lastname: Payne
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield.
authors.forename: Melanie
authors.initials: M
authors.lastname: Rimmer
mesh_terms: D019317:Evidence-Based Medicine; D006301:Health Services Needs and Demand; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D063127:Secondary Health Care / Q000458:organization & administration*; D006113:United Kingdom
keywords: demand management; general practice; narrative synthesis; primary care; referral; systematic review