Abstract
BackgroundIn Australia and in the United Kingdom (UK) access to specialists is sanctioned by General Practitioners (GPs). It is important to understand how practitioners determine which patients warrant referral.MethodsA self-administered structured vignette postal survey of General Practitioners in Western Australia and the United Kingdom. Sixty-four vignettes describing patients with colorectal symptoms were constructed encompassing six clinical details. Nine vignettes, chosen at random, were presented to each individual. Respondents were asked if they would refer the patient to a specialist and how urgently. Logistic regression and parametric tests were used to analyse the dataResultsWe received 260 completed questionnaires. 58% of 'cancer vignettes' were selected for 'urgent' referral. 1632/2367 or 69% of all vignettes were selected for referral. After adjusting for clustering the model suggests that 38.4% of the variability is explained by all the clinical variables as well as the age and experience of the respondents. 1012 or 42.8 % of vignettes were referred 'urgently'. After adjusting for clustering the data suggests that 31.3 % of the variability is explained by the model. The age of the respondents, the location of the practice and all the clinical variables were significant in the decision to refer urgently.ConclusionGPs' referral decisions for patients with lower bowel symptoms are similar in the two countries. We question the wisdom of streaming referrals from primary care without a strong evidence base and an effective intervention for implementing guidelines. We conclude that implementation must take into account the profile of patients but also the characteristics of GPs and referral policies.
Highlights
In Australia and in the United Kingdom (UK) access to specialists is sanctioned by General Practitioners (GPs)
In this structured vignette survey of GPs we aim to explore the impact of a variety of clinical and respondent characteristics on GPs' decision to refer patients with lower bowel symptoms
Our data support the notion that the application of guidelines is moderated, or even negated, by the characteristics of those for whom they are intended. This is important because, in Britain, GPs are involved in prioritising health care expenditure in a so-called 'primary care led' National Health Service and serve as both poacher and game keeper [32]. In this structured vignette study selection of patients with colorectal symptoms reflects the data from surveys of actual referrals and does not indicate consistently evidence based practice
Summary
In Australia and in the United Kingdom (UK) access to specialists is sanctioned by General Practitioners (GPs). In Australia, as in the United Kingdom (UK), patients can only access specialists after referral by a General Practitioner (GP) but notwithstanding these similarities there are marked differences in health care organisation. Data from the UK suggest that cancer referral guidelines do not appear to have changed referral practice in Britain or outcomes for cancer patients [10]. In this structured vignette survey of GPs we aim to explore the impact of a variety of clinical and respondent characteristics on GPs' decision to refer patients with lower bowel symptoms
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