Comparative performance information plays no role in the referral behaviour of GPs.

Nicole Abm Ketelaar,Jozé C Braspenning,Gert P Westert,Glyn Elwyn,Marjan J Faber

doi:10.1186/1471-2296-15-146

Abstract

BackgroundComparative performance information (CPI) about the quality of hospital care is information used to identify high-quality hospitals and providers. As the gatekeeper to secondary care, the general practitioner (GP) can use CPI to reflect on the pros and cons of the available options with the patient and choose a provider best fitted to the patient’s needs. We investigated how GPs view their role in using CPI to choose providers and support patients.MethodWe used a mixed-method, sequential, exploratory design to conduct explorative interviews with 15 GPs about their referral routines, methods of referral consideration, patient involvement, and the role of CPI. Then we quantified the qualitative results by sending a survey questionnaire to 81 GPs affiliated with a representative national research network.ResultsSeventy GPs (86% response rate) filled out the questionnaire. Most GPs did not know where to find CPI (87%) and had never searched for it (94%). The GPs reported that they were not motivated to use CPI due to doubts about its role as support information, uncertainty about the effect of using CPI, lack of faith in better outcomes, and uncertainty about CPI content and validity. Nonetheless, most GPs believed that patients would like to be informed about quality-of-care differences (62%), and about half the GPs discussed quality-of-care differences with their patients (46%), though these discussions were not based on CPI.ConclusionDecisions about referrals to hospital care are not based on CPI exchanges during GP consultations. As a gatekeeper, the GP is in a good position to guide patients through the enormous amount of quality information that is available. Nevertheless, it is unclear how and whether the GP’s role in using information about quality of care in the referral process can grow, as patients hardly ever initiate a discussion based on CPI, though they seem to be increasingly more critical about differences in quality of care. Future research should address the conditions needed to support GPs’ ability and willingness to use CPI to guide their patients in the referral process.

Highlights

Comparative performance information (CPI) about the quality of hospital care is information used to identify high-quality hospitals and providers
Most general practitioner (GP) believed that patients would like to be informed about quality-ofcare differences (62%), and about half the GPs discussed quality-of-care differences with their patients (46%), though these discussions were not based on CPI
Decisions about referrals to hospital care are not based on CPI exchanges during GP consultations

Summary

Introduction

Comparative performance information (CPI) about the quality of hospital care is information used to identify high-quality hospitals and providers. In healthcare systems where the GPs are the gatekeepers of secondary care, which they are in the Netherlands and the UK, GPs refer their patients to specialists for further examination, diagnosis, or treatment In doing so, they play an important intermediary role between patient and hospital [1,2,3]. International studies have shown that the referral is traditionally affected by previous experiences with specialists, perceptions of specialists’ interactions with patients, office location, specialists’ medical skills, and patient preferences [4,5,6,7]. The current focus on the patient’s choice of healthcare provider, with CPI for identifying the quality of provider performance [8,9], calls for GPs to reflect anew on the current referral process

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Discussion

Conclusion