Article Figures & Data
Tables
Characteristics No. % * Numbers may not sum to 776 for each variable because of missing data. Patient characteristics (n = 776 referred patients)* Age 0–19 y 70 9.0 20–39 y 179 23.1 40–49 y 146 18.8 50–59 y 133 17.2 60–69 y 120 15.5 ≥ 70 y 127 16.4 Sex Male 311 40.1 Female 465 59.9 Patient/parent education Less than high school degree 121 15.6 High school or some college 374 48.2 College or technical school graduate 207 26.7 Graduate or professional degree 74 9.5 Annual family income <$20,000 215 30.7 $20,000–$40,000 218 31.1 $40,000–$60,000 123 17.5 >$60,000 145 20.7 Patient race White 693 91.8 Nonwhite 62 8.2 Health plan characteristics Health plan payer (n = 648) Private 408 63.0 Medicaid 71 11.0 Medicare 145 22.3 Uninsured 24 3.7 Gatekeeping and primary care payment type (n=630) No gatekeeping 294 46.7 Gatekeeping with fee-for-service payment 177 28.1 Gatekeeping with capitated payment 159 25.2 Referral decision characteristics (n = 776 referrals) Type of specialist referred to Medical subspecialist 259 33.4 Surgical subspecialist 362 46.6 Obstetrician/gynecologist 34 4.4 Nonphysician clinician 89 11.5 Mental health professional 32 4.1 Primary expectation of specialist Consultation for advice 81 10.6 Perform a test or procedure 385 50.3 Shared responsibility for ongoing management 220 28.7 Transferred responsibility for ongoing management 80 10.4 Expected duration of specialist involvement <3 mo 493 64.0 3–12 mo 173 22.5 >12 mo 104 13.5 Urgency of referral—how soon patient should see specialist <1 wk 265 34.6 1 wk – 1 mo 406 52.9 At the patient’s discretion 96 12.5 Duration of relationship with referring physician <3 mo 92 12.0 3 mo – 5 y 295 38.5 ≥5 y 379 49.5 Referring physician/staff scheduled specialist appointment No 163 21.2 Yes 605 78.8 Referring physician gave patient the name of a specialist No 87 11.3 Yes 686 88.7 Referring physician transferred patient information to specialist No 113 14.7 Yes 655 85.3 Referring physician characteristics (n = 133 physicians) Years in practice <5 y 28 21.1 6–14 y 38 28.6 ≥15 y 67 50.4 Sex Male 106 79.7 Female 27 20.3 Specialty Family physician 123 92.5 General internist 10 7.5 Referring practice characteristics (n = 81) Location Urban 67 84.8 Rural 12 15.2 US census division Northeast 12 14.8 Midwest 28 34.6 South 24 29.6 West 17 21.0 Size Solo, 2- to 3-physician practice 30 37.0 Large practice (>3 physicians) 51 63.0 Patient-Reported Referral Completion Referring Physician-Reported Referral Completion Yes No. (%) No No. (%) Totals Yes 551 (85.6) 64 (48.5) 615 No 93 (14.4) 68 (51.5) 161 Totals 644 (100.0) 132 (100.0) 776 - Table 3.
Associations Between Patient-Reported Referral Completion and Patient, Referral Decision, Physician, Practice, and Health Plan Characteristics: Univariate Analyses
Predictor Completed/Total Referrals* No. Referral Completion % P Value Note: Associations with P <.20 only are shown in this table. * For each bivariate association, denominators may vary because of missing values. Overall 644/776 83.0 Patient race White 581/693 83.8 Nonwhite 46/62 74.2 .06 Medicaid health plan Yes 53/71 74.6 No 591/705 83.8 .07 Expected duration of specialist involvement <3 mo 418/493 84.8 3–12 mo 141/173 81.5 >12 mo 80/104 76.9 .13 Duration of patient-physician relationship <3 mo 69/92 75.0 3 mo – 5 y 240/295 81.4 ≥5 y 325/379 85.8 .04 Referring physician/staff scheduled appointment No 122/163 74.8 Yes 515/605 85.1 <.01 Referring physician years in practice <5 y 95/125 76.0 6–14 y 191/229 83.4 ≥15 y 358/422 84.8 .07 Referring physician specialty Internist 41/56 73.2 Family physician 603/720 83.8 .04 Referring physician practice location Urban 555/674 82.3 Rural 72/80 90.0 .08 Predictors of Referral Completion Adjusted Odds Ratio 95% Confidence Interval Note: Predictor variables were retained in the final model only if they significantly improved model fit (P <.05 for the likelihood ratio test). Logistic regression with the generalized estimating equation was used to estimate odds ratios and their 95% confidence intervals. Medicaid health plan Yes 0.51 0.28–0.92 No Referent Duration of patient-physician relationship <3 mo Referent 3 mo – 5 y 1.65 0.87–3.13 ≥5 y 2.14 1.14–4.00 Referring physician/staff scheduled appointment No Referent Yes 1.91 1.19–3.06
Additional Files
The Article in Brief
Specialty Referral Completion Among Patients: Results from the ASPN Referral Study
Christopher B. Forrest, MD, PhD, and colleagues
Background When primary care doctors refer patients to specialists, they may not be aware of whether the visit takes place. This lack of information could result in patients receiving duplicate medical services or not receiving needed services at all. This study set out to understand more about referrals of patients to specialists from the viewpoints of both patients and doctors.
What This Study Found About 8 in 10 patients visit a specialist within 3 months of being referred by their primary care doctor. The most common reasons for not visiting the specialist are lack of time, a belief that the health problem has resolved, or disagreement with the doctor about the need for a specialist. Patients in Medicaid plans are less likely than others to visit the specialist and more likely to have the referral denied by their health plan. Patients who have a longer relationship with the primary care doctor and those whose appointment is scheduled by the primary care doctor�s office are more likely to visit the specialist.
Implications
- Primary care offices can encourage referred patients to visit specialists by helping to schedule the appointment and promoting an ongoing relationship between the patient and the primary care doctor.
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