Frequency of Referral and Patient Characteristics in Group Practice

Penchansky, Roy; Fox, Dan

doi:10.1097/00005650-197009000-00004

Cited by 46 publications

(11 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other investigative avenues in studying referral have focused on the effects of physician practice arrangements and of patient factors such as the source of payment and patient race, on physician referral rates (5-7). Penchansky and Fox ( 5 ) found that in group practices, black patients appear to be referred less often than white patients, but they found no consistent difference between prepaid groups and fee-for-service groups with respect to referral rates. Moscovice et a1 (6) and Glenn and coworkers (7) reported that the majority of referrals were for management of a specific problem rather than a transfer of patient care responsibility.…”

Section: Discussionmentioning

confidence: 98%

Referral of musculoskeletal disease patients by family and general practitioners

Felson

Meenan

Dayno

et al. 1985

Arthritis & Rheumatism

View full text Add to dashboard Cite

We surveyed general and family practitioners to evaluate their patterns of referring musculoskeletal disease patients to rheumatologists and orthopedists. Patients who had rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis were most often referred to rheumatologists, whereas patients with osteoarthritis, persistent low back pain, and post-traumatic knee pain were most often referred to orthopedists. As conditions worsened in severity, referrals were more frequent. Patients with conditions that were difficult to diagnose, such as possible shoulder tendinitis that was unresponsive to initial nonsteroidal therapy, undiagnosed polyarthritis, and intermittent knee swelling with pain, were most often treated without referral and, when referred, were most often sent to orthopedists. Belief in the effectiveness of rheumatologists or orthopedists correlated strongly with reported referral behavior, yet most respondents considered themselves capable of managing the majority of patients with musculoskeletal diseases. Neither practice arrangement, board certification, nor educational background affected referral behavior. However, younger physicians were Submitted for publication November 19, 1984; accepted in revised form March 11, 1985. more likely (P = 0.002) to refer patients to rheumatologists. Multivariate analysis showed that the significant predictors of global referral behavior were belief in the effectiveness of subspecialists and a small number of musculoskeletal problems seen by the generalist. The predictors of referral to rheumatologists were belief in rheumatologist efficacy and young physician age.The referral of patients with musculoskeletal disorders is of vital interest to rheumatologists. The prevalence of primary care visits for rheumatic conditions is extremely high, yet the referral rate for these conditions is quite low (1). A small change in the percentage of patients referred would have an enormous impact on the demand for rheumatologists and the spectrum of diseases treated by rheumatologists. Nonetheless, subspecialists in general, and rheumatologists in particular, have not systematically studied which patients are being referred and which are not. Furthermore, although social scientists have investigated social networking and physician demographic characteristics and attitudes as determinants of referral behavior (2,3), the reasons behind the decision to refer some patients with specific diseases, while not referring others, have not been studied.We surveyed a group of general and family practitioners to determine how often specific musculoskeletal conditions are referred and to investigate the reasons behind the referrals. METHODSWe developed a questionnaire designed to assess the frequency of referrals of patients with musculoskeletal diseases and to evaluate the reasons for the referral. The questionnaire underwent pilot testing with 10 general inter-

show abstract

Section: Discussionmentioning

confidence: 98%

Referral of musculoskeletal disease patients by family and general practitioners

Felson

Meenan

Dayno

et al. 1985

Arthritis & Rheumatism

View full text Add to dashboard Cite

show abstract

“…Social attributes (e.g., age, gender, ethnicity, race, and socioeconomic status) are read by physicians in their interaction with patients (Cicourel, 1985;Crane, 1975;West, 1984 race, and social class influence diagnosis and treatment decisions, such as the interpretation of symptoms (Armitage & Schneiderman, 1979), referrals (Penchansky & Fox, 1980), surgical intervention (Egbert & Rothman, 1977), and use of paramedical personnel (Rushing & Miles, 1977). Research also demonstrates that physicians' assessments of social cues inhibit communication and information sharing between physician and patient.…”

Section: Social Cuesmentioning

confidence: 99%

“…Researchers have analyzed patients' social characteristics (e.g., gender, race, and social class, based on medical records) and physicians' choice of medication, referral, and/or operation (see, e.g., Egbert & Rothman, 1977;Hooper et al, 1982;Penchansky & Fox, 1980;Perkoff & Anderson, 1970;Rushing & Miles, 1977). These studies are limited by their concentration on one patient cue and/or one physician response and an oversight of the interpretation of cues.…”

Section: Previous Measures Of the Influence Of Patient Cues On Physicmentioning

confidence: 99%

Reliable, Silent, Hysterical, or Assured: in Their Medical Decision Making

Geist¹,

Hardesty²

1990

Health Communication

View full text Add to dashboard Cite

“…Ashcraft (1978) employed the phrase &dquo;managing physician&dquo; and related it to patients having or seeking a usual source. In attempting to explain the choice of a closed-panel HMO by high utilizers who formerly employed emergency or outpatient departments, she suggested, &dquo;They may have perceived an opportunity of establishing a relationship with a managing physician ... as a way of reducing the fragmentation of services associated with settings where no single physician has responsibility for providing total care.&dquo; That physicians assume different responsibility roles-even physicians with a similar scope of practice-became clear to the author during his research on referrals in group practice (Penchansky and Fox 1970).…”

Section: Existing Definitionsmentioning

confidence: 99%

Patient-Provider Concordance: A Review and Conceptualization

Penchansky

1986

Medical Care Review

Self Cite

View full text Add to dashboard Cite

The existence and character of the relationship between a patient and provider are probably key variables determining the performance of the medical care system. Prior analyses of this relationship have addressed it as three largely distinct areas: the patient having a usual source, a personal physician, or a central source; the concept of managing physician, primary physician or gatekeeper; and,-the patientphysician interpersonal or therapeutic relationship.If the relationship between provider and patient is important, then there is a need to answer the questions: Are there factors that influence the existence or strength of the relationship and, if so, what are they? How do the existence and strength of the relationship influence choice of source, use, quality, compliance, efficiency, and satisfaction? Will the addition of a measure (or measures) of the existence and characteristics of the patient-provider relationship improve our ability to explain the functioning of the health 'care system? How can the relationship between patient and system or provider be characterized in ways useful for research and policy analysis? This article has four major objectives: to establish the importance of usual source (personal physician or managing physician) to health at UQ Library on June 18, 2015 mcr.sagepub.com Downloaded from

show abstract

Frequency of Referral and Patient Characteristics in Group Practice

Cited by 46 publications

References 5 publications

Referral of musculoskeletal disease patients by family and general practitioners

Referral of musculoskeletal disease patients by family and general practitioners

Reliable, Silent, Hysterical, or Assured: in Their Medical Decision Making

Patient-Provider Concordance: A Review and Conceptualization

Contact Info

Product

Resources

About