Abstract
BackgroundMultiprofessional practice is a key component in primary care. Examining general practitioner (GP) referral frequency to non-physician health professionals (NPHP) can provide information about how primary care is organised and works which is useful for policymakers. Our study aimed to describe French GP referral frequency to various NPHPs in France and identify associated factors.MethodsThis is an ancillary study to the observational, cross-sectional (ECOGEN) study conducted in 2011/2012 in France among 128 GPs. Data about consultations using the standardised International Classification of Primary Care (ICPC-2), and patient and GP characteristics were collected from 20,613 GP consultations. Referrals were identified through inductive and deductive approaches using ICPC-2 codes, keywords, and deep, open manual searches. Referral frequency was described overall and per NPHP. Patient, GP, and consultation-related factors associated with referral rates were described for the three most frequently identified NPHPs. To minimise potential sources of bias, this observational study followed the STROBE guidelines.ResultsFrench GPs referred 6.8% of patients to NPHPs, with physiotherapists, podiatrists, and nurses accounting for 85.2% of referrals. Older patients, retired patients, multiple health problems managed, and longer consultation durations were found to be associated with higher referral rates (p < 0.001). Specific trends were observed for nurse, physiotherapist, and podiatrist referrals. Women (p < 0.001) and regular patients (p = 0.002) were more likely to receive physiotherapy referrals while people with no professional activity were less likely (p < 0.001). Female GPs and those working in urban practices were more likely to issue a physiotherapy referral (p < 0.001), while GPs working in rural practices (p < 0.001) and those with higher annual consultation numbers (p = 0.002) were more likely to refer to a nurse. Working in multiprofessional centres appeared to have little impact on referral rates, being only slightly associated with podiatrist referrals (p = 0.003).ConclusionsReferral frequency is more associated with patient characteristics and clinical situations than GP-related factors suggesting patients needing referral most are most often referred. Furthermore, the three NPHPs that GPs refer to the most are those for which a referral is required for reimbursement in France, suggesting that health system legislation and NPHP reimbursement are strong determinants for referrals.
Highlights
Multiprofessional practice is a key component in primary care
Referral frequency is more associated with patient characteristics and clinical situations than general practitioner (GP)-related factors suggesting patients needing referral most are most often referred
The three non-physician health professionals (NPHP) that GPs refer to the most are those for which a referral is required for reimbursement in France, suggesting that health system legislation and NPHP reimbursement are strong determinants for referrals
Summary
Multiprofessional practice is a key component in primary care. Examining general practitioner (GP) referral frequency to non-physician health professionals (NPHP) can provide information about how primary care is organised and works which is useful for policymakers. General practitioners (GP) play a key role in most health care systems since they are often responsible for coordinating patient care pathways, including referrals to non-physician health professionals (NPHPs) [10] and both the primary and secondary care sector [11]. In some countries they act as gatekeepers with GP referral validating health insurance reimbursement for consultations with other health professionals, including some NPHPs. GP referral to NPHPs is a key indicator for multiprofessional practice [12]. Examining GP referral frequency to different NPHPs, and factors associated with referrals, can provide information about how primary care is organised and works
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