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Prevalence of health problems and primary care physicians' specialty referral decisions.
J Fam Pract. 2001 May; 50(5):427-32.JF

Abstract

OBJECTIVE

The researchers 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

The researchers 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

The frequency of a health problem's presentation to primary care (practice prevalence) was defined as the percentage of all visits made to family physicians, general internists, and general pediatricians for that particular problem. The researchers 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.

Authors+Show Affiliations

Health Services Research and Development Center, Department of Health Policy and Management, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland 21205, USA. cforrest@jhsph.eduNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11350708

Citation

Forrest, C B., and R J. Reid. "Prevalence of Health Problems and Primary Care Physicians' Specialty Referral Decisions." The Journal of Family Practice, vol. 50, no. 5, 2001, pp. 427-32.
Forrest CB, Reid RJ. Prevalence of health problems and primary care physicians' specialty referral decisions. J Fam Pract. 2001;50(5):427-32.
Forrest, C. B., & Reid, R. J. (2001). Prevalence of health problems and primary care physicians' specialty referral decisions. The Journal of Family Practice, 50(5), 427-32.
Forrest CB, Reid RJ. Prevalence of Health Problems and Primary Care Physicians' Specialty Referral Decisions. J Fam Pract. 2001;50(5):427-32. PubMed PMID: 11350708.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of health problems and primary care physicians' specialty referral decisions. AU - Forrest,C B, AU - Reid,R J, PY - 2001/02/08/received PY - 2001/02/08/revised PY - 2001/5/15/pubmed PY - 2001/7/13/medline PY - 2001/5/15/entrez SP - 427 EP - 32 JF - The Journal of family practice JO - J Fam Pract VL - 50 IS - 5 N2 - OBJECTIVE: The researchers 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: The researchers 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: The frequency of a health problem's presentation to primary care (practice prevalence) was defined as the percentage of all visits made to family physicians, general internists, and general pediatricians for that particular problem. The researchers 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. SN - 0094-3509 UR - https://www.unboundmedicine.com/medline/citation/11350708/Prevalence_of_health_problems_and_primary_care_physicians'_specialty_referral_decisions_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=11350708.ui DB - PRIME DP - Unbound Medicine ER -