Abstract
BackgroundThere is a large variation in referral rates to secondary care among GPs, which is partly unexplained.AimTo explore associations between reasons for referral to secondary care and patient, GP, and healthcare characteristics.Design and settingA cross-sectional study in Northern Norway.MethodData were derived from 44 (42%) of 104 randomly selected GPs between 2008 and 2010. GPs scored the relevance of nine predefined reasons for 595 referrals from 4350 consecutive consultations on a four-level categorical scale. Associations were examined by multivariable ordered and multivariable multilevel logistic regression analyses.ResultsMedical necessity was assessed as a relevant reason in 93% of the referrals, 43.7% by patient preference, 27.5% to avoid overlooking anything, and 14.6% to reassure the patient. The higher the referral rates, the more frequently the GPs referred to avoid overlooking anything. Female GPs referred to reassure the patient and due to perceived deficient medical knowledge significantly more often than male GPs. However, perceived easy accessibility of specialists was significantly less frequently given as a reason for referral by female GPs compared with male GPs. When the GPs scored the referrals to be of lesser medical necessity, male GPs referred significantly more frequently than female GPs to reassure the patient due to patient preference and perceived deficient medical knowledge.ConclusionThere are striking differences in reasons for referral between Norwegian male and female GPs and between GPs with high and low referral rates, which reflects difficulties in handling professional uncertainty. Referring to reassure the patients, especially when referrals are less medically necessary, may reflect consideration and acquiescence towards the patients.
Highlights
The large variation in referral rates to secondary care among GPs is partly unexplained.[1]
Recruitment Power calculation indicated a need for approximately 2500 consultations in each subgroup to detect a 25% difference in referral rates (a = 0.05, b = 0.8)
Of all 476 GPs in Northern Norway 88 GPs were excluded, due to the incompatibility of electronic patient records (EPR) with the electronic questionnaire (n = 44), vacancy (n = 35), the two practices housing three GPs participating in piloting (n = 8), and one GP practising without EPR
Summary
The large variation in referral rates to secondary care among GPs is partly unexplained.[1] Patients’ age, sex, and morbidity explain less than 40% of the variation, and practice and GP characteristics less than 10%.2. The decision-making process for referrals is complex; increased consumerism in health care[3] and increased legal rights of patients may increase patients’ preference for referral. The decision to refer should be based on the patient’s medical condition, needs, and an assessment of the optimal level of health care. The patient should be referred at the right time after adequate pre-referral management, and after an appropriate process that takes the patient’s wishes into account.[4] Referrals may have several purposes, including:. There is a large variation in referral rates to secondary care among GPs, which is partly unexplained
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