TY - JOUR T1 - Referral interventions from primary to specialist care: a systematic review of international evidence JF - British Journal of General Practice JO - Br J Gen Pract SP - e765 LP - e774 DO - 10.3399/bjgp14X682837 VL - 64 IS - 629 AU - Lindsay Blank AU - Susan Baxter AU - Helen Buckley Woods AU - Elizabeth Goyder AU - Andrew Lee AU - Nick Payne AU - Melanie Rimmer Y1 - 2014/12/01 UR - http://bjgp.org/content/64/629/e765.abstract N2 - 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.Aim To review the international evidence on interventions to manage referral from primary to specialist care.Design and setting Systematic review.Method Iterative, systematic searches of published and unpublished sources public health, health management, management, and grey literature databases from health care and other industries were undertaken to identify recent,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. ER -