Tags

Type your tag names separated by a space and hit enter

Patient, physician, and community factors affecting referrals to specialists in Ontario, Canada: a population-based, multi-level modelling approach.
Med Care. 2003 Apr; 41(4):500-11.MC

Abstract

QUESTION ADDRESSED

This population-based study examines the factors affecting referrals by primary care physicians (PCPs) to specialists.

MATERIALS AND METHODS

Multilevel Poisson models were used to test the impact of patient, physician and community-level variables on the referral rate (the number of office-based specialist referrals per patient by the patient's customary PCP in fiscal year 1997/98). Patients from each of 6972 PCPs with sufficient data in Ontario were examined.

RESULTS

The average patient had 0.56 referrals per year (range 0-61). Referrals were higher at ages 1 and 77 to 78, and among women of childbearing age. Chronic disease variables were strongly correlated with referral rates. Patients in poor neighborhoods had more referrals, because they had more chronic diseases. After controlling for disease, individuals in the top 9% wealthiest neighborhoods had 4% more referrals. Female physicians made 8% more referrals than men. Older physicians referred more because they saw older patients; after controlling for patient age, physician age had no effect. Referrals were 14% higher in cities with medical schools compared with other cities and 12% lower in small towns. However, local specialist supply was unrelated to referral rates.

CONCLUSION

This study improves our understanding of the impact of physician gender and age on referrals. It suggests that community type, not specialist supply, predicts variations in referrals. Lastly, it identifies preferential access to specialists among high-income earners, even within Canada's universal health insurance system. However, this effect is modest, suggesting that the system does provide reasonably equitable access to referrals.

Authors+Show Affiliations

Institute for Clinical Evaluative Sciences, Toronto, Ontario. ben@ices.on.caNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12665714

Citation

Chan, Benjamin T B., and Peter C. Austin. "Patient, Physician, and Community Factors Affecting Referrals to Specialists in Ontario, Canada: a Population-based, Multi-level Modelling Approach." Medical Care, vol. 41, no. 4, 2003, pp. 500-11.
Chan BT, Austin PC. Patient, physician, and community factors affecting referrals to specialists in Ontario, Canada: a population-based, multi-level modelling approach. Med Care. 2003;41(4):500-11.
Chan, B. T., & Austin, P. C. (2003). Patient, physician, and community factors affecting referrals to specialists in Ontario, Canada: a population-based, multi-level modelling approach. Medical Care, 41(4), 500-11.
Chan BT, Austin PC. Patient, Physician, and Community Factors Affecting Referrals to Specialists in Ontario, Canada: a Population-based, Multi-level Modelling Approach. Med Care. 2003;41(4):500-11. PubMed PMID: 12665714.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient, physician, and community factors affecting referrals to specialists in Ontario, Canada: a population-based, multi-level modelling approach. AU - Chan,Benjamin T B, AU - Austin,Peter C, PY - 2003/4/1/pubmed PY - 2003/4/19/medline PY - 2003/4/1/entrez SP - 500 EP - 11 JF - Medical care JO - Med Care VL - 41 IS - 4 N2 - QUESTION ADDRESSED: This population-based study examines the factors affecting referrals by primary care physicians (PCPs) to specialists. MATERIALS AND METHODS: Multilevel Poisson models were used to test the impact of patient, physician and community-level variables on the referral rate (the number of office-based specialist referrals per patient by the patient's customary PCP in fiscal year 1997/98). Patients from each of 6972 PCPs with sufficient data in Ontario were examined. RESULTS: The average patient had 0.56 referrals per year (range 0-61). Referrals were higher at ages 1 and 77 to 78, and among women of childbearing age. Chronic disease variables were strongly correlated with referral rates. Patients in poor neighborhoods had more referrals, because they had more chronic diseases. After controlling for disease, individuals in the top 9% wealthiest neighborhoods had 4% more referrals. Female physicians made 8% more referrals than men. Older physicians referred more because they saw older patients; after controlling for patient age, physician age had no effect. Referrals were 14% higher in cities with medical schools compared with other cities and 12% lower in small towns. However, local specialist supply was unrelated to referral rates. CONCLUSION: This study improves our understanding of the impact of physician gender and age on referrals. It suggests that community type, not specialist supply, predicts variations in referrals. Lastly, it identifies preferential access to specialists among high-income earners, even within Canada's universal health insurance system. However, this effect is modest, suggesting that the system does provide reasonably equitable access to referrals. SN - 0025-7079 UR - https://www.unboundmedicine.com/medline/citation/12665714/Patient_physician_and_community_factors_affecting_referrals_to_specialists_in_Ontario_Canada:_a_population_based_multi_level_modelling_approach_ L2 - https://doi.org/10.1097/01.MLR.0000053971.89707.97 DB - PRIME DP - Unbound Medicine ER -