Communication between general practitioners and medical specialists in the referral process: a cross-sectional survey in 34 countries

Giacomo Scaioli,Peter M M Spreeuwenberg,Willemijn L A Schäfer,Peter P Groenewegen,François G Schellevis,Wienke G W Boerma

doi:10.1186/s12875-020-01124-x

Abstract

BackgroundThe communication of relevant patient information between general practitioners (GPs) and medical specialists is important in order to avoid fragmentation of care thus achieving a higher quality of care and ensuring physicians’ and patients’ satisfaction. However, this communication is often not carried out properly. The objective of this study is to assess whether communication between GPs and medical specialists in the referral process is associated with the organisation of primary care within a country, the characteristics of the GPs, and the characteristics of the primary care practices themselves.MethodsAn analysis of a cross-sectional survey among GPs in 34 countries was conducted. The odds ratios of the features that were expected to relate to higher rates of referral letters sent and communications fed back to GPs were calculated using ordered logistic multilevel models.ResultsA total of 7183 GPs from 34 countries were surveyed. Variations between countries in referral letters sent and feedback communication received did occur. Little of the variance between countries could be explained. GPs stated that they send more referral letters, and receive more feedback communications from medical specialists, in countries where they act as gatekeepers, and when, in general, they interact more with specialists. GPs reported higher use of referral letters when they had a secretary and/or a nurse in their practice, used health information technologies, and had greater job satisfaction.ConclusionsThere are large differences in communication between GPs and medical specialists. These differences can partly be explained by characteristics of the country, the GP and the primary care practice. Further studies should also take the organisation of secondary care into account.

Highlights

The communication of relevant patient information between general practitioners (GPs) and medical specialists is important in order to avoid fragmentation of care achieving a higher quality of care and ensuring physicians’ and patients’ satisfaction
Previous studies showed that high rates of communication between physicians were associated with better patient outcomes and greater satisfaction among both patients and physicians [10,11,12,13]
By using data from 34 countries, our study investigates whether differences between countries in the organisation of their primary care systems are related to the rate of communication between primary and secondary care

Summary

Introduction

The communication of relevant patient information between general practitioners (GPs) and medical specialists is important in order to avoid fragmentation of care achieving a higher quality of care and ensuring physicians’ and patients’ satisfaction. This communication is often not carried out properly. An increasing number of patients with chronic diseases and multimorbidity [5] usually receive health care from both general practitioners (GPs) and several medical specialists This highlights the need for a connection between all the health care events of each patient, in short that care is coordinated [4, 6]. Low rates of communication seem to decrease the quality of care due to delayed diagnoses and treatments, repeated diagnostic examinations, increased rates of adverse events, and avoidable hospitalisations [10, 14,15,16,17]

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