Referring patients to specialists: a structured vignette survey of Australian and British GPs
MetadataShow full item record
BACKGROUND: In Australia and in the United Kingdom (UK) access to specialists is sanctioned by General Practitioners (GPs). It is important to understand how practitioners determine which patients warrant referral. METHODS: A self-administered structured vignette postal survey of General Practitioners in Western Australia and the United Kingdom. Sixty-four vignettes describing patients with colorectal symptoms were constructed encompassing six clinical details. Nine vignettes, chosen at random, were presented to each individual. Respondents were asked if they would refer the patient to a specialist and how urgently. Logistic regression and parametric tests were used to analyse the data RESULTS: We received 260 completed questionnaires. 58% of 'cancer vignettes' were selected for 'urgent' referral. 1632/2367 or 69% of all vignettes were selected for referral. After adjusting for clustering the model suggests that 38.4% of the variability is explained by all the clinical variables as well as the age and experience of the respondents.1012 or 42.8 % of vignettes were referred 'urgently'. After adjusting for clustering the data suggests that 31.3 % of the variability is explained by the model. The age of the respondents, the location of the practice and all the clinical variables were significant in the decision to refer urgently. CONCLUSION: GPs' referral decisions for patients with lower bowel symptoms are similar in the two countries. We question the wisdom of streaming referrals from primary care without a strong evidence base and an effective intervention for implementing guidelines. We conclude that implementation must take into account the profile of patients but also the characteristics of GPs and referral policies.
This article is published under the Open Access publishing model and distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0/ Please refer to the licence to obtain terms for any further reuse or distribution of this work.
Showing items related by title, author, creator and subject.
Do Pharmacists know which patients with bowel syptoms should seek further medical advice? A survey of Pharmacists practicing in community pharmacy in Western AustraliaJiwa, Moyez; Spilsbury, Katrina; Duke, Janine (2010)Background: Pharmacists in Australia are routinely asked to advise people with lower bowel symptoms. Clinical, demographic, and working environment parameters may affect whether appropriate referral for advanced care is ...
An investigation of factors that influence general practitioners’ referral of computed tomography scans in patients with headacheSun, Zhonghua; Ng, Curtise Kin Cheung; Halkett, Georgia; Meng, R.; Jiwa, Moyez (2013)Aim: In assessing patients with headaches, general practitioners (GPs) play an important role in determining which patients require computed tomography (CT) scans. The purpose of this study was to identify factors that ...
An investigation of factors that influence general practitioners’ referral of computed tomography scans in patients with headacheSun, Zhonghua; Ng, Curtise Kin Cheung; Halkett, Georgia; Meng, R.; Jiwa, Moyez (2013)Aim: In assessing patients with headaches, general practitioners (GPs) play animportant role in determining which patients require computed tomography (CT)scans. The purpose of this study was to identify factors that ...