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Prevalence of Health Problems and Primary Care Physicians' Specialty Referral Decisions.
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- Author(s): Forrest, Christopher B.; Reid, Robert J.
- Source:
Journal of Family Practice. May2001, Vol. 50 Issue 5, p427-432. 6p. 4 Charts, 1 Graph. - Source:
- Additional Information
- Subject Terms:
- Abstract: OBJECTIVE: We tested the hypothesis that the frequency with which patients present to primary care physicians with certain types of health problems is inversely related to the chances of specialty referral during an office visit. STUDY DESIGN: Cross-sectional analysis. POPULATION: We used a data set composed of 78,107 primary care visits from the 1989 to 1994 National Ambulatory Medical Care Surveys. The physicians completed questionnaires after office visits. OUTCOMES MEASURED: We defined the frequency of a health problem's presentation to primary care (practice prevalence) as the percentage of all visits made to family physicians, general internists, and general pediatricians for that particular problem. We estimated the correlation between a condition's practice prevalence and its referral ratio (percentage of visits referred to a specialist) and used logistic regression to estimate the effect of practice prevalence on the chances of referral during a visit. RESULTS: The practice prevalence of a condition and its referral rate had a strong inverse linear relationship (r=-0.87; P <.001). Compared with visits made for the uncommon problems, the odds of referral for those with intermediate or high practice prevalence were 0.49 (P=.004) and 0.22 (P <.001), respectively. Surgical conditions were referred more often than medical conditions, and a greater burden of comorbidities increased the odds of referral. CONCLUSIONS: Primary care physicians are more likely to make specialty referrals for patients with uncommon problems than those with common conditions. This finding highlights the responsible judgment primary care physicians employ in recognizing the boundaries of their scope of practice. Practice prevalence is a defining feature of the primary care-specialty care interface. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Journal of Family Practice is the property of Frontline Medical Communications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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