Typologies in GPs’ referral practice

Olav Thorsen,Jörn Schulz,Miriam Hartveit,Lars Fosse,Anders Bærheim,Geir Egil Eide,Jan Olav Johannessen

doi:10.1186/s12875-016-0495-y

Abstract

BackgroundGPs’ individual decisions to refer and the various ways of working when they refer are important determinants of secondary care use. The objective of this study was to explore and describe potential characteristics of GPs’ referral practice by investigating their opinions about referring and their self-reported experiences of what they do when they refer.MethodsObservational cross-sectional study using data from 128 Norwegian GPs who filled in a questionnaire with statements on how they regarded the referral process, and who were invited to collect data when they actually referred to hospital during one month. Only elective referrals were recorded. The 57 participants (44,5 %) recorded data from 691 referrals. The variables were included in a principal component analysis. A multiple linear regression analysis was conducted to identify typologies with GP’s age, gender, specialty in family medicine and location as independent variables.ResultsEight principal components describe the different ways GPs think and work when they refer. Two typologies summarize these components: confidence characterizing specialists in family medicine, mainly female, who reported a more patient-centred practice making priority decisions when they refer, who confer easily with hospital consultants and who complete the referrals during the consultation; uncertainty characterizing young, mainly male non-specialists in family medicine, experiencing patients’ pressure to be referred, heavy workload, having reluctance to cooperate with the patient and reporting sparse contact with hospital colleagues.ConclusionsTraining specialists in family medicine in patient-centred method, easy conference with hospital consultant and cooperation with patients while making the referral may foster both self-reflections on own competences and increased levels of confidence.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0495-y) contains supplementary material, which is available to authorized users.

Highlights

GPs’ individual decisions to refer and the various ways of working when they refer are important determinants of secondary care use
The 70 non-participants who only filled in the questionnaire in the Continuous professional development (CPD) group meetings, but did not participate in the recording of data in referrals, had a mean age of 47 years, with 55% males and 61% specialists in family medicine
Two typologies By abduction [23, 25] of the principal components we found two typologies which describe GPs when they refer: 1. Confidence (PC 2, 3, 5) characterizing experienced female GPs who are specialists in family medicine, who involve the patients in the referral process, making priority decisions when they refer, who confer with hospital consultants and who complete the referrals during the consultation, without spending too much time

Summary

Introduction

GPs’ individual decisions to refer and the various ways of working when they refer are important determinants of secondary care use. The objective of this study was to explore and describe potential characteristics of GPs’ referral practice by investigating their opinions about referring and their self-reported experiences of what they do when they refer. In 2011we showed that GPs regarded the referring process as asymmetric and sometimes embarrassing and wanted improved dialogue with hospital specialists [13]. Studies have shown that better ecommunication between GPs and hospital consultants and more advanced electronic referral decision may facilitate this process [18, 19]. The aim for this study was to explore and describe potential characteristics of GPs’ referral practice by investigating their opinions about referring and their self-reported experiences of what they do when they refer

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Conclusion