Physician Referral Patterns Research Articles

Physician referral patterns to a breast cancer support program.

The purpose of this study was to describe the differences between physicians who did and did not refer their patients with breast cancer to the American Cancer Society's Reach to Recovery program, as well as to determine the factors associated with these physician referral patterns. This descriptive cross-sectional study included 54 physicians who had and 23 physicians who had not referred their patients with breast cancer to the Mile High Unit Reach to Recovery program in 1999. Participating physicians completed a questionnaire about their knowledge, behaviors, and beliefs regarding Reach to Recovery, the characteristics of the patients they referred, and their own demographic and practice characteristics. General surgeons were more likely than all other specialties to refer patients to the Reach to Recovery program. The program is a part of the American Cancer Society. Feedback from patients about their experiences with Reach to Recovery and the proportion of patient time spent caring for patients with breast cancer were all positively associated with referral. These findings show that those providing support programs, such as Reach to Recovery, need to use targeted strategies to ensure that physicians are aware of the services they provide and that patients relay their experiences back to their referring physician. Because the value of social support programs for women with breast cancer has been established, physicians can become valuable partners in helping more women gain access to these programs.

Radiosurgery for brain metastases: is whole brain radiotherapy necessary?

Purpose: Because whole brain radiotherapy (WBRT) may cause dementia in long-term survivors, selected patients with brain metastases may benefit from initial treatment with radiosurgery (RS) alone reserving WBRT for salvage as needed. We reviewed results of RS ± WBRT in patients with newly diagnosed brain metastasis to provide background for a prospective trial. Methods and Materials: Patients with single or multiple brain metastases managed initially with RS alone vs. RS + WBRT (62 vs. 43 patients) from 1991 through February 1997 were retrospectively reviewed. The use of upfront WBRT depended on physician preference and referral patterns. Survival, freedom from progression (FFP) endpoints, and brain control allowing for successful salvage therapy were measured from the date of diagnosis of brain metastases. Actuarial curves were estimated using the Kaplan-Meier method. Analyses to adjust for known prognostic factors were performed using the Cox proportional hazards model (CPHM) stratified by primary site. Results: Survival and local FFP were the same for RS alone vs. RS + WBRT (median survival 11.3 vs. 11.1 months and 1-year local FFP by patient 71% vs. 79%, respectively). Brain FFP (scoring new metastases and/or local failure) was significantly worse for RS alone vs. RS + WBRT (28% vs. 69% at 1 year; CPHM adjusted p = 0.03 and hazard ratio = 0.476). However, brain control allowing for successful salvage of a first failure was not significantly different for RS alone vs. RS + WBRT (62% vs. 73% at 1 year; CPHM adjusted p = 0.56). Conclusions: The omission of WBRT in the initial management of patients treated with RS for up to 4 brain metastases does not appear to compromise survival or intracranial control allowing for salvage therapy as indicated. A randomized trial of RS vs. RS + WBRT is needed to assess survival, quality of life, and cost in good-prognosis patients with newly diagnosed brain metastases.

Healthcare utilization and referral patterns in the initial management of new-onset, uncomplicated, low back workers' compensation disability claims.

Most episodes of low back pain are considered non-specific in nature, with the vast majority resolving within 2 weeks and almost all resolving within 6 weeks regardless of the medical intervention. Recently published clinical guidelines have clearly delineated a limited set of circumstances that would indicate the need for specialist referral. The purpose of this study was to describe the healthcare utilization and physician referral patterns for new-onset, uncomplicated, low back workers' compensation disability cases randomly selected from a large insurance carrier data source. The provision of care in urgent care centers and emergency departments for both initial and main sources of care occurred more frequently than was probably indicated. For this selected group of uncomplicated low back pain cases, specialist care was provided more commonly than would be expected or indicated (36% of the sample was seen by a surgeon, while only 2% received surgery). In addition, referral to specialists (other than occupational medicine specialists) was often made sooner than would be expected or indicated, with a median of 13 days for such referrals. Such overutilization of resources can reasonably be expected to increase overall medical costs.

Managed care and physician referral.

In the era of managed care, fundamental changes are occurring in the American health care system that are altering physician referral patterns. Faced with higher premiums that erode profits and competitiveness, employers, government, and nonprofit agencies are contracting with managed care organizations, which control costs partly by imposing constraints and incentives on physician referral behavior. As more and more Americans are covered by managed care plans, it becomes more important to understand how managed care organizations control access to specialists and how these controls affect health outcomes. The authors present a model defining the expected influence of managed care on physician referral based on social exchange theory and the empirical literature. They conclude with a discussion of the future research implications of the model.

Enthusiasm or uncertainty: small area variations in the use of mammography services in Ontario, Canada.

STUDY OBJECTIVE: To examine the variation in mammography utilisation in relation to age group and indication across health planning regions in Ontario, Canada. DESIGN: This study includes all women aged...

Contradictions in women's health care provision: A case study of attendance for breast cancer screening

Breast cancer screening facilities operated by the Ontario Breast Screening Program (OBSP) have recently been added to the existing geography of diagnostic mammography facilities in hospitals and private clinics in Eastern Ontario. While diagnostic facilities require a physician's referral for access, the new centres offer mammograms by self-referral. Other work has shown the utilization of mammography screening services to be quite low despite widespread acceptance of early diagnosis through mammographic screening as the best method to lower breast cancer mortality. Major findings are that spatial variation does exist in attendance rates in the townships and census tracts surrounding the screening centre. At the regional level, physician referral patterns and the presence of local diagnostic mammography units appear to affect the uptake of screening at the Kingston facility. The individual level analysis confirms the importance of the primary care physician's referral with two-thirds of the client sample indicating that they were referred for screening by their family physician. The sample of clients are also very mobile women who have comparatively greater access to financial resources than other women of screening age. The results of ecological and individual level analyses of attendance at OBSP's Kingston Centre reveal contradictions in the provision of this service. Spatially, the centres follow a location pattern of a much higher order health facility yet women are expected to include screening as part of their routine care. Attenders at the Centre were found to be of higher socioeconomic status, married and have access to a private automobile. The finding that the primary care physician's referral is an important prerequisite for attendance raises questions about the feasibility of providing health care for women which encourages individual responsibility for health within the existing paternalistic health care system.

Importance of emergency physicians as referral sources for academic medical centers

To identify physician referral patterns and factors involved in the patient referral process. A telephone survey conducted on a systematic sample of physicians who referred at least one patient a month to a tertiary care center. A major southeastern tertiary care academic medical center. Self-identified emergency physicians, family physicians, general surgeons, internists, obstetrician-gynecologists, and pediatricians. None. Emergency physicians comprised 6% of the surveyed sample. Emergency physicians referred the largest number of patients each month to a tertiary care center (40 patients per month) compared with the other target specialists, who referred an average of 16 patients per month (P < .05). Specialty services most often requested by emergency physicians were internal medicine, trauma, and cardiology. Emergency physicians refer more patients to academic medical centers than any other specialty. Academic medical centers should target emergency physicians if they wish to increase their patient referral base.

Podiatric Utilization Referral Patterns at an Army Medical Center

Presented is the first descriptive data on a large military Podiatry Clinic supporting largely combat troops. Data consist of initial podiatric problems of soldiers and other beneficiaries of podiatric care. Demographic, physician referral patterns, and other pertinent summarized survey information of outpatient utilization at the Podiatry Clinic, Madigan Army Medical Center, Fort Lewis, Washington, are examined. Findings are based on new and initial consult referrals from the month of November 1988. The results indicated that some clinics needed inservices and further education concerning podiatric care. This study has led to the implementation of changes which have resulted in better and more timely patient care.

Physician Referrals and the Medical Market Place

Factors determining the extent to which physicians obtain new patients through referrals are examined. A more thorough understanding of physician referral patterns can help to explain how competitive forces function in this market and how physician characteristics and credentials affect individual performance. Referral networks promote entry by young physicians into both primary and nonprimary care medical markets. Nevertheless, there are marked differences in referral patterns between primary care and nonprimary care providers. For instance, referrals are directly related to the degree of market competition and board-certification status among primary care physicians but not among nonprimary care specialists. Membership in a group practice is related to significantly more referral activity among nonprimary care physicians but not among primary care providers. No significant differences were found in referral patterns by physician sex. Although foreign medical graduates (FMGs) receive proportionately fewer referrals than do U.S. medical graduates, the differences are not large. While earlier research suggests that the returns to board certification are higher for female physicians, the present study finds little evidence that board certification is particularly helpful to either female physicians or to FMGs in terms of obtaining patients on referral.

A computerized MIS to support the administration of quality patient care in HMOs organized as IPAs.

All federally qualified HMOs must develop and implement quality assurance programs for monitoring the quality of care, the quality of services, and the costs of inpatient and ambulatory care. Such quality assurance programs are diverse and vary in administrative structure, criteria, review procedures, feedback, and decision making. This paper describes a computerized quality assurance reporting system operating in an HMO organized as an IPA network. The design and use of various MIS reports containing information on inpatient utilization and costs, physician office visits and physician practice patterns, physician productivity, physician referral patterns and costs, and the health problems of members are presented. The importance of these MIS-generated reports on the operations of IPA medical groups and the HMO and how they are used by medical directors, HMO management, and committees charged with quality assurance responsibilities is also included.