PT  - JOURNAL ARTICLE
AU  - Christopher B. Forrest
AU  - Efrat Shadmi
AU  - Paul A. Nutting
AU  - Barbara Starfield
TI  - Specialty Referral Completion Among Primary Care Patients: Results From the ASPN Referral Study
AID  - 10.1370/afm.703
DP  - 2007 Jul 01
TA  - The Annals of Family Medicine
PG  - 361--367
VI  - 5
IP  - 4
4099  - http://www.annfammed.org/content/5/4/361.short
4100  - http://www.annfammed.org/content/5/4/361.full
SO  - Ann Fam Med2007 Jul 01; 5
AB  - PURPOSE This study describes referral completion from the perspectives of patients and primary care physicians and identifies predictors of adherence to the referral recommendation. METHODS We observed a cohort of 776 referred patients from the offices of 133 physicians in 81 practices and 30 states. Referring physicians and patients completed self-administered questionnaires at the time of the referral decision and 3 months later. RESULTS Physicians reported that 79.2% of patients referred had a specialist visit, and 83.0% of patients indicated they completed the referral. The most common reasons for not completing the referral were “lack of time” and patient belief that the “health problem had resolved.” The κ statistic for patient-physician agreement on referral completion was 0.34, indicating only fair concordance. Patients in Medicaid plans were less likely than others to complete the referral, and more likely to experience a health plan denial. A longer duration of the patient relationship with the primary care physician and physician/staff scheduling of the specialty appointment were both positive predictors of referral completion. CONCLUSIONS About 8 in 10 patients referred from primary care complete a specialty referral within 3 months. Findings from this study suggest that referral completion rates may be increased by assisting patients with scheduling their specialty appointments and promoting continuity of care.