AbstractsMedical & Health Science

Summary Background The referral rates of general practitioners (GPs) are an important determinant of secondary care utilisation. The considerable variation in these rates between GPs cannot be explained by patient morbidity alone. Other factors, like health care organisation, GP characteristics and patient preference play an important role, but the extent of their mutual contributions is not known. Aims and methods In this thesis we aimed to study GPs’ decisions to refer patients to secondary care (consultations and hospital admissions) and/or radiological examination. In a survey with a cross-sectional design, a random sample of GPs in Northern Norway completed electronic questionnaires after each consultation in a consecutive manner. We estimated and explored GPs’ referral rates, reasons for referral, and GPs’ expected medical benefit of referrals. Results 13.7% of 4350 consultations resulted in referral to secondary care and 4.2% to radiological examination, with a striking range among the GPs. Female GPs referred more frequently than male GPs. Furthermore, their referrals were more often substantiated by the reason ‘to reassure the patient’ and ‘perceived deficient medical knowledge’, but less often by ‘perceived easy accessibility of specialists’. The higher the referral rates, the more frequently the GPs referred to avoid overlooking anything. The GPs expected one-quarter of their referrals to secondary care to yield little or no medical benefit, and this was reported more often in referrals from GPs with high referral rates, referrals to private secondary care, and when the patient introduced the issue of referral. Conclusion The results from the present study indicate a 50% increase in GPs’ referral rates to secondary care over the last 20 years, and that GPs expected little or no medical benefit from a substantial proportion of their referrals. Parts of the variation in referral rates reflected how GPs handled professional uncertainty and patient preference.