MANAGEMENT GUIDELINES FOR IMPROVEMENT OF OTOLARYNGOLOGY REFERRALS FROM PRIMARY-CARE PHYSICIANS

OBJECTIVE AND DESIGN: A prospective evaluation of the effectiveness of otolaryngology evaluation, treatment, and referral guidelines develop ed collaboratively by otolaryngologists and primary care physicians on referrals and access to otolaryngology. Comparisons of appropriate to unnecessary referrals, the percentage of patients referred with disor ders addressed to those without disorders addressed in the guidelines, access to otolaryngology, and questionnaire evaluations of primary ca re physician and patient satisfaction were measured before and after g uideline implementation. RESULTS: A significant decrease in appropriat e to unnecessary referrals was seen, from 55% before to 12% after guid elines. The percentage of patients seen within 1 month of scheduling i mproved from 39% to 59%. Guideline-addressed disorders decreased from 63% to 40%, The need for patients to see another physician for the ref erred symptom while waiting to see an otolaryngologist decreased from 31% to 3%. Patient satisfaction with wait times improved, Eighty-six p ercent of the primary care physicians used the guidelines, and 85% wan ted to expand the guidelines to other specialty areas. CONCLUSIONS: Ma nagement and referral guidelines are effective in improving patient ac cess and the ratio of appropriate to unnecessary referrals. Such guide lines are well accepted and used by primary care practitioners in this setting.