The nature of all 'inappropriate referrals' made to a countywide physical activity referral scheme: Implications for practice

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Abstract
Objective The aim of this study was to evaluate the impact of a centralised referral mechanism (CRM) upon the number and type of'inappropriate referrals' made to a countywide physical activity referral scheme. Design Case study. Method Phase 1: Hierarchical Content Analysis of 458 'inappropriate referrals' made to a countywide scheme over a 28-month period. Phase 2: Chi-square analysis to compare patients removed on the basis of psychosocial or medical reasons by reason for original referral and gender. One-way ANOVA to compare both groups by age. Results Reasons for referral were classified into first, second and third order themes. Two third level themes emerged from the data: medical contraindicator and psychosocial reasons. Significantly more people were removed on the basis of psychosocial factors rather than medical reasons (χ2=77.17; p2=49.31; p2=40.96; p2=11.76; p2=10.78; p<0.01) more likely to be removed for psychosocial reasons. Patients removed from the scheme for medical reasons were also significantly (F=13.00; p<0.01 ) older than those in the psychosocial group. Conclusions This study provides support for the introduction of a CRM within a countywide physical activity referral scheme. The need for existing referral guidelines to be extended to include holistic recom mendations with regard to both the medical conditions that are appropriate for referral and also the stage of readiness of the patient to take-up the referral is recommended.