Referrals from GPs to specialist health services – attitudes, wishes and future possibilities.
We did two qualitative and one quantitative study. The first was a focus group study with GPs in CPD groups, published in 2013: General practitioners' reflections on referring: an asymmetric or non-dialogical process? Thorsen O, Hartveit M, Baerheim A. Scand J Prim Health Care. 2012 Dec;30(4):241-6. doi: 10.3109/02813432.2012.711190. Epub 2012 Oct 10. The second was an individual study with hospital consultants: The consultants' role in the referring process with general practitioners: partners or adjudicators? a qualitative study. Thorsen O, Hartveit M, Baerheim A. BMC Fam Pract. 2013 Oct 11;14:153. doi: 10.1186/1471-2296-14-153. Both analyses were done by using systematic text condensation. The third study was a quantitative registration of impressions, facts and feelings in the referral process using a principal component analysis to find typologies for GPs who refer to hospital. The results from this study are ready for submission in January 2016. The dissertation for PhD will be completed in 2016.
Our results confirm the variety of referral rates between GPs. Many GPs consider the relationship to hospital specialists as imbalanced and referring as difficult, not always knowing what makes a referral good and comprehensive. Hospital consultants consider many referrals as inappropriate and avoidable. Different typologies of referring physicians can explain much of the variety in referring rates. Experienced GPs, especially female, are more confident and feel more secure when they refer. Better communication between GPs and hospital consultants and specialty training in family medicine/general practice may create a more balanced relationship between the two levels and may reduce the number of referrals to hospital. The results from this study can be useful in educational programs for young GPs and specialist candidates in family medicine. Individual as well as professional skills should focus on a patient-centred referral process and good communication with hospital consultants, to improve GPs’ judgements of their competences and prevent fear and uncertainty when referring.
Referrals from general practitioners to specialist health services - attitudes, wishes and future possibilities
Improving the referral process between physicians is critical to facilitating timely access to specialty care. There are several aspects with the referral process that require significant improvements. The purpose of this study is to investigate important factors and components in the referral process for better clinical pathways for patients.
Within the health system, communication between the different levels of care is essential for a patient’s clinical pathway and medical treatment. This includes the referral process: how and why the patient is sent from the primary care level to specialist health services. From 2011 to 2013 we published two qualitative studies with individual and focus group interviews with general practitioners (GPs) and hospital consultants about the referral process. These studies showed that GPs see referring as asymmetric and sometimes humiliating and want an improved dialogue with the hospital specialists. The consultants reported a considerable workload assessing referrals from GPs and prioritizing patients for specialist services. Good referrals could make the prioritization process easier. Better communication, such as a telephone call to confer with a hospital specialist before referral, was requested. The third part of this project is a quantitative observational cross-sectional study analyzing factors and components in the referral process, including GPs’ opinions about referring and registrations of what they do in practice when they refer. During 23 continuous professional development (CPD) group meetings 123 GPs filled in a questionnaire about the referral process and were invited to record characteristics in the hospital referrals during one month. 58 of the participants agreed to participate, and data from 709 referrals were registered. We used a Principal Component analysis, and the results will be published in 2015 in an international journal.