Explaining Variation in General Practitioner Referrals to Hospital

Abstract

Reported rates of referral by individual general practitioners to hospitals range from less than 1% of all consultations to more than 20%. Research on variations in rates of referral by general practitioners in the UK is reviewed here. Studies have largely failed to account for variation either in terms of differences in the characteristics of patients or differences in the doctors and their practices. It is argued that this failure arises because most studies do not distinguish between different types of referral or reasons for making a referral. In order to begin to explain variations it is necessary to identify the stages in the complex process of decision making. A theoretical model of the referral decision is advanced, which is intended to provide a framework for further research on the referral process.

Change in appropriate referrals to nephrologists after the introduction of automatic reporting of the estimated glomerular filtration rate

“…Factors that may be responsible for inappropriate referrals may include lack of knowledge about appropriate referrals; lack of resources to manage patients with mild chronic kidney disease in primary care; patients' demands to see a specialist; and different perspectives about what constitutes an appropriate referral. 31,32 Further research may help to delineate the reasons for inappropriate referral. 33 Interventions to decrease inappropriate referrals would help to limit the total number of referrals, thus limiting unnecessary consumption of expensive resources.…”

Outcomes of referrals from general practice

“…Many studies have been published on the rates of referrals by GPs to secondary care (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). The results of these studies have usually been in agreement.…”

Old boys’ network in general practitioners’ referral behavior?

“…Whereas several UK studies did not identify any significant impact of age or experience on a GP's referral rate (Cummins et al, 1981;Wilkin and Smith, 1987), one Finnish study (Vehvilainen et al, 1996) and another UK study (Rashid and Jagger, 1990) reported higher referral rates for younger and relatively inexperienced primary care providers.…”