Review and development of referral criteria used to identify patients with diabetes who would benefit from attending a pharmacist-led cardiovascular out-patient clinic

Abstract

Abstract Development and validation of new referral criteria: a triangulation study at the Pharmacist-led Diabetes Cardiovascular risk Reduction Clinic, Edinburgh. The Pharmacist-led Diabetes Cardiovascular risk Reduction (DCVR) clinic has been running at the Western General Hospital (WGH), Edinburgh, for 8 years. It was decided to review the referral process of patients and the referral criteria. Semi-structured interviews were performed with nine clinicians at the diabetes clinic, WGH. The interviews were transcribed and analysed with thematic codes. New referral criteria were developed and applied to a cross-sectional survey of 1000 patients selected randomly from a total of 2911 patients registered at the diabetes clinic at the 19th of March 2012. Data was recorded on a database for 944 patients from the main list of 1000 patients identified from the Scottish Care Information – Diabetes Collaboration (SCI-DC). Eight clinicians were referring patients to the clinic and one clinician was not aware of the clinic and only four clinicians were aware of the referral form. The interviews showed that clinicians’ main reason for referring patients was blood pressure control in complicated patients. The five combinations with most referred patients identified had two criteria in common: systolic BP >130 mmHg and microalbumin >2.5 mg/mmol. To provide a consistent service for patients there is a requirement for continuity in referral of patients to the pharmacist-led DCVR clinic. Our findings suggest there is a need to raise awareness of the clinic among physicians and to improve communication between physicians and pharmacist in terms of patient outcomes.