Clinical guidelines as decision support for referrals from primary care

This work describes the use of clinical guidelines in public health care for decision support in a primary care record system. The clinical guidelines were used for decision support in primary care in order to improve the quality of electronic referrals to a hospital. Guidelines were developed by the specialists at the hospital, but the design and the development of the system was done in collaboration with general practitioners working in primary care. This paper sums up the findings from a study six months after the introduction of the decision support system, and is based on interviews with users in primary care. The work processes differed between the practices; General practitioners who wrote the referrals after the patient had left the office did not find the system as useful as the ones who wrote them when the patient was present. The general practitioners were reluctant to use guidelines that resulted in an additional workload in terms of providing the hospital with more information than before, but found the system useful as a support for assuring that they made the right clinical decisions. The guidelines were also seen as useful as a support for refusing to refer the patient to specialized care.