چکیده (انگلیسی):

Background:The rising volume of referrals to secondary care is a continuing concern in the NHS in England, with
considerable resource implications. Referral management centres (RMCs) are one of a range of initiatives brought in
to curtail this rise, but there is currently limited evidence for their effectiveness, and little is known about their
mechanisms of action. This study aimed to gain a better understanding of how RMCs operate and the factors
contributing to the achievement of their goals. Drawing on the principles of realist evaluation, we sought to elicit
programme theories (the ideas and assumptions about how a programme works) and to identify the key issues to
be considered when establishing or evaluating such schemes.
Methods:Qualitative study with a purposive sample of health professionals and managers involved in the
commissioning, set-up and running of four referral management centres in England and with GPs referring through
these centres. Semi-structured interviews were conducted with 18 participants. Interviews were audio-recorded and
transcribed. Data were analysed thematically.
Results:Interview data highlighted the diverse aims and functions of RMCs, reflecting a range of underlying
programme theories. These included the overarching theory that RMCs work by ensuring the best use of limited
resources and three sub-theories, relating to how this could be achieved, namely, improving the quality of referrals
and patient care, reducing referrals, and increasing efficiency in the referral process. The aims of the schemes,
however, varied between sites and between stakeholders, and evolved significantly over time. Three themes were
identified relating to the context in which RMCs were implemented and managed: the impact of practical and
administrative difficulties; the importance and challenge of stakeholder buy-in; and the dependence of perceived
effectiveness on the aims and priorities of the scheme. Many RMCs were described as successful by those involved,
despite limited evidence of reduced referrals or cost-savings.
Conclusions:The findings of this study have a number of implications for the development of similar schemes,
with respect to the need to ensure clarity of aims and to identify indicators of success from the outset, to
anticipate scheme evolution and plan for potential changes with respect to IT systems and referral processes. Also
identified, is the need for further research that evaluates the effectiveness and cost effectiveness of particular
models of RMC