Use of Map of Medicine in primary care has led to a significant reduction in inadequate referrals from GPs, according to a new study.

Doctors from the Institute of Nephrology in Cardiff looked at the impact of a patient care pathway for chronic kidney disease on Map of Medicine.

They found use of the knowledge management tool cut inadequate referrals by almost 50% and also led to a slight reduction in overall referrals.

The researchers studied referrals for chronic kidney disease (CKD) from GPs in five local health boards covering 550,000 people in South Wales following the inclusion of CKD in the Quality and Outcomes Framework in 2006.

The doctors reported that there was an abrupt increase in referrals from the inclusion of CKD in the QoF with an overall increase of 61% across 30 months since April 2006.

In November 2007, a renal patient pathway was launched on Map of Medicine to provide guidance on referral together with the minimal clinical data required to prioritise an outpatient appointment. The pathway also provides support to enable discharge of patients to primary care with guidelines on future monitoring and re-referral.

The study, published in QJM, reports that before the launch of the patient pathway initiative 23% of referrals were classified as having inadequate information, a figure which fell to around 14% of referrals following the introduction of the pathway. The total number of referrals also fell following introduction of the pathway.

The researchers report that 62% of practices were registered with Map of Medicine and found that the local health board with the lowest QoF reported prevalence of renal disease was the one with the lowest number of practices registered to use the knowledge management tool.

The researchers add: “Across the whole trust referrals from the practices which were registered with the Map were more likely to require follow up in the nephrology clinic suggesting a higher proportion of appropriate referrals. In addition practices registered with the Map were less likely to generate referrals with inadequate information.”

The study reports that the structured care pathway posted on Map of medicine was also associated with earlier discharge with the number of outpatient visits cut from an average of just over four to one and a half.


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