What is the relationship between general practitioners' community referrals, and hospital referrals to an old age psychiatric service?

Abstract

There is a large variation in the referral rates of general practitioners (GPs) to specialist services. There is also evidence that GPs under-refer patients with dementia and depression to old age psychiatric services. However, little is known about individual GP referral rates to these services. Patients may be referred to psychiatric services by GPs in the community (community referrals), or by physicians or surgeons, while the patients are receiving medical or surgical care in hospital (hospital referrals). One way of controlling for GP variables, such as practice size and the age profile of patients, may be to examine the relationship between hospital and community referrals for each GP. Our hypothesis was that there would be a positive correlation between these types of referral. Six hundred and seventy-four new referrals from 62 local GPs were examined over a 6-year period. The GPs made an average of 7.1 community referrals and 3.8 of their patients were hospital referrals. There was a large variation in the number of referrals (range 1-45). However, there was a significant positive relationship between the number of hospital and community referrals for each GP ( p =0.001). These findings support the hypothesis, and suggest that it may be useful to use the ratio, hospital to community referrals, to identify GPs with abnormal referral patterns.