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| Research article summary (published 27 Feb 2002): |
Family physicians' referral decisions: results from the ASPN referral study.
Full Abstract
OBJECTIVE:
To examine family physicians' referral decisions, which we conceptualized as having 2 phases:
whether to refer followed by to whom to refer.
STUDY DESIGN:
Prospective cohort study.
POPULATION:
All visits (N = 34,519) and new referrals (N = 2534) occurring during 15 consecutive business days in the offices of 141 family physicians in 87 practices located in 31 states.
OUTCOMES MEASURED:
Rates of referral, reasons for referral, practitioners referred to, health problems prompting referral, and reasons for selecting particular specialists.
RESULTS:
Approximately 1 in 20 (5.1%) office visits led to referral. Although 68% of referrals were made by physicians during office visits, 18% were made by physicians during telephone conversations with patients, 11% by office staff with input from the physician, and 3% by staff without physician input. Physicians endorsed a mean of 1.8 reasons for making a referral. They sought specialists' advice on either diagnosis or treatment for 52.1% of referrals and asked the specialist to direct medical management for 25.9% and surgical management for 37.8%. Patient request was one reason for 13.6% of referrals. Fifty conditions accounted for 76% of all referrals. Surgical specialists were sent the largest share of referrals (45.4%), followed by medical specialists (31.0%), nonphysician clinicians (12.1%), obstetrician-gynecologists (4.6%), mental health professionals (4.2%), other practitioners (2.0%), and generalists (0.8%). Physicians recommended a specific practitioner to the patient for most (86.2%) referrals. Personal knowledge of the specialist was the most important reason for selecting a specific specialist.
CONCLUSIONS:
Referrals are commonly made during encounters other than office visits, such as telephone conversations or staff-patient interactions, in primary care practice. Training in the referral process should ensure that family physicians obtain the skills necessary to expand their scope of practice, when appropriate; determine when and why a patient should be referred; and identify the type of practitioner to whom the patient should be sent.
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Author information
Author/s: Forrest, Christopher B (CB); Nutting, Paul A (PA); Starfield, Barbara (B); von Schrader, Sarah (S);
Affiliation: Health Services Research & Development Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA. cforrest(-atsign-)jhsph.edu
Grants: R01 HS09377 (Agency:United States AHRQ)
Journal and publication information
Publication Type: Journal Article; Multicenter Study; Research Support, U.S. Gov't, P.H.S.
Journal: The Journal of family practice (J Fam Pract), published in United States. (Language: eng)
Reference: 2002-Mar; vol 51 (issue 3) : pp 215-22
Dates: Created 2002/04/29; Completed 2002/05/24; Revised 2007/11/14;
PMID: 11978231, status: MEDLINE (last retrieval date: 11/6/2008)
Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.
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