Strengthen the Referral System for Patients with Thyroid Cancer. Because the existing referral system for patients with suspected thyroid cancer and other diseases was not entirely effective, a consultant to CCIP spent one week in June 1999 to evaluate the existing referral system. He worked with counterparts from the MOH and the targeted Oblasts, and with Drs. Xxxxx and Contis during his visit. He developed recommendations to strengthen the referral system and the mobile screening teams' relationships with the raion, oblast and regional health centers. Revised referral forms for the thyroid and psychosocial components were finalized during the summer of 1999, were amended in Year Two and were subsequently used by the mobile screening units in all oblasts. Copies of the referral forms are attached to this Report as Attachment E. During the final three years of the CCIP, bi-monthly referral reports were prepared by each UAHC secretary and collated by CCIP's Data Base Manager. Each report contained the names of the referred child, the type of referral made, and the raion or oblast health organization to which the child was referred. It was the responsibility of each UAHC secretary to contact the family, or if direct family contact was not possible, to contact the appropriate school officials, to determine whether the child and family followed through with the referral. The referral report also contained information on the diagnostic and/or therapeutic assistance provided by the health institution. We monitored whether the child and family received financial assistance for travel costs associated with the referral. We also provided financial incentives to the referral physician and/or psychologist when he/she submitted a completed referral form for each child examined. Compliance with the patient referrals was low, reportedly because parents could not afford the transportation costs to take their child to the referred specialist. As a result, and after discussion with USAID in 2001, it was decided that a special effort would be made to evaluate children with thyroid nodules greater than 10 mm in size. A protocol was developed to implement this outreach referral effort which was reviewed and approved by all five UAHC Directors. This outreach effort involved sending a Pediatric Endocrinologist to examine children with nodules, and a nurse to draw blood for thyroid and hormone tests. Children requiring a fine needle biopsy were referred to the local oblast health center or Kiev (the results of this activity are described I Se...
Strengthen the Referral System for Patients with Thyroid Cancer. The amended referral forms for the thyroid and psychosocial components are now being used by the mobile screening units in all oblasts. As stated in previous Quarterly Reports, we have been told that some patients do not follow through with the referral to a raion, oblast or Kyiv center because their families were too poor to pay for the cost of transportation and accommodations. In a meeting in November 1999, General X. Xxxxxxx, the Deputy Minister in the Ministry of Emergencies advised us that lack of funds should not prevent patients from travelling to the referral centers because the Ministry had created a non-governmental organization (NGO) to pay for such travel. Although actual numbers data are not available, we will continue to monitor this situation to ensure families requiring assistance do indeed obtain the necessary funds to pay for their trip to the referral centers.
