des patients ? vers les services/personnes ad hoc ?

Ph-B fait une excellente objection : d'après la source, se sont les "health workers" qui ne reçoivent pas de counter-referrals. J'avoue être perplexe : c'est logiquement le patient qui est "réorienté" vers un centre/ un spécialiste, et un "counter-referral" semble être une réorientation dans le sens contraire, vers un service plus générique (2e source).

Aussi trouvé une réponse de Liz Askew sur Proz - pas trop d'accord sur sa traduuction mais les références sont certainement intéressantes : https://www.proz.com/kudoz/english-to-french/medical-health-...



referral : orientation vers un service, un spécialiste
the plot thickens :

"• Client ! Provider: Client uses mobile phone to find provider/facility that provides services they are seeking
5. FACILITATED*
The facilitated referral model has four components, of which multiple actions within each component must be met to qualify as a facilitated referral.
Component 1: CHW provides initial services before a referral, especially in cases where the nearest facility is far away (all actions must be completed)
• CHW is able to counsel client on the full method mix, including LAPMs
• CHW is able to provide client with effective short-acting modern methods of contraception (condom, injectable, pills, Standard Days Method [SDM], emergency contraception) to ensure that client does not get pregnant before receiving LAPM
Component 2: CHW explains referral and promotes compliance with referral (all actions must be completed)
• CHW counsels client about why referral is necessary and promotes compliance with referral
• CHW fills out referral slip/records in referral book and gives referral slip to client
Component 3: Monitoring of referral (all actions must be completed)
• CHW records referrals in register
• Health worker who sees client follows up with the CHW with a “counter-referral,” which explains what services were delivered and any information on follow-up care
• Referral and counter-referral are tracked in the health information system and the outcome of the referral is discussed during supervision
Component 4: CHW addresses potential barriers to referral (at least one action must be completed)
• CHW inquires about barriers to referral and works with client to address them
• CHW has access to or can inform client about source of funds in the community to help client pay for travel to health facility and for services at the facility
• CHW accompanies client to health facility to ensure client receives services
• CHW has direct relationship with specific health facilities and/or providers; as a result, CHW can ensure that clients are referred to services that are available and able to meet clients’ needs
* This model was originally described by Winch et al. (2005) in regards to CHW treatment and referral of children with acute respiratory infection (ARI) and has been adapted for the purposes of CBFP."
Situation Analysis of Community-Based Referrals for Family Planning ...
https://www.advancingpartners.org/sites/.../apc_situation_an...



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Note added at 8 hrs (2019-07-15 07:37:01 GMT)
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"Referrals and counter-referrals facilitate access to different levels of care and different health institutions to ensure comprehensive care covering the full range of health care services:
Vision: promotion, prevention, Healthy Population, Healthy early diagnosis, treatment, rehabilitation, palliative Environment care, and support for self–management of chronic
conditions.
There is a bi-directional relationship in referrals and to promote healthy lifestyles among Primary, Secondary and Tertiary Care; as while most referrals take place from primary upwards, there are occasions when there will be referrals from tertiary or secondary care downwards."
Patient Transfer Manual - Ministry of Health Jamaica
https://moh.gov.jm/.../Revised-MOH-Policy-and-Procedure-Manu...



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Note added at 9 hrs (2019-07-15 07:53:20 GMT)
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"Referral and counter referral are key features of district health systems, particularly in case of emergencies. (1;2) They allow for a rational division of labour between health centres and hospital. In scarcely populated areas with dispersed populations, such as rural Niger, they are vital: health centres offer only a limited range of interventions and access to the hos¬pital is difficult and costly. Distance and lack of transport are major obstacles and causes of delays for surgical and obstetric referrals. (3-10) Many studies, including focus groups with members of the public in Nigeria, Ghana and Niger blame poor roads, scarce vehicles, and high transportation costs for the malfunction of the referral system and the delays in reaching emergency care. (11-13)
There are not many options for dealing with obstetric and other emergencies that go beyond a health centre's capacities. Although HC could improve their competence in order to avoid referrals to a certain extent, it is hard to imagine that the necessary technical means (diagnostic and therapeutic) could be significantly decentralised beyond the present level. Emergency referral can be improvised relying on private transport or organised by calling for an ambulance - provided there is a way of communicating between the health centre and the district hospital. (6;11;14-16) Although there is an obvious need to deal with this problem, it remains difficult to convince decision makers in poor countries that it is feasible and worthwhile to provide for emergency referral. "
The referral system: a neglected element in the health district ... - Vub
https://www.vub.be/.../referral-system-neglected-element-hea...

Une contre-référence a lieu lorsqu'un patient qui a été dirigé vers un spécialiste est renvoyé au médecin de soins primaires ou à l'établissement qui l'a initialement envoyé.