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Referrals of adult patients from primary care: demographic disparities and their relationship to HMO insurance.
J Fam Pract. 1997 Jul; 45(1):47-53.JF

Abstract

BACKGROUND

Increasing enrollment in managed care organizations and dissatisfaction with policies to restrict direct access to specialists have intensified interest in referrals from primary care physicians to specialists. We examined the associations of demographic factors and insurance with referrals of adult patients by primary care physicians.

METHODS

Office visits of adult patients to primary care physicians (general practitioners, family physicians, and internists) reported in the National Ambulatory Care Survey for the years 1985 through 1992 were used to examine referrals by primary care physicians. Regression analyses were adjusted for patient factors (age, sex, race, insurance, case mix, diagnostic category, new problem or not, new patient or not, and visit length), physician factors (age, sex, specialty, and degree of specialization), and practice factors (proportion of HMO patients, rural location, region, and study year).

RESULTS

Overall, 4.5% of patients were referred compared with 7.5% of patients with HMO insurance. After adjustment, an increased likelihood of referral was associated with being a male patient, having fewer medications prescribed, not being seen before for the presenting problem, a longer visit, less physician specialization, seeing a female physician, seeing an internist, and seeing a physician with a greater proportion of patients with HMO insurance. Among patients with HMO insurance, no gender disparity in referral rate was observed, and patients who also had Medicaid or Medicare insurance were more likely to be referred.

CONCLUSIONS

Male patients are more likely to be referred. HMO insurance may reduce this gender disparity and increase the access of patients with Medicaid and Medicare to specialty care.

Authors+Show Affiliations

Primary Care Institute, Highland Hospital, Rochester, New York, USA.No affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

9228914

Citation

Franks, P, and C M. Clancy. "Referrals of Adult Patients From Primary Care: Demographic Disparities and Their Relationship to HMO Insurance." The Journal of Family Practice, vol. 45, no. 1, 1997, pp. 47-53.
Franks P, Clancy CM. Referrals of adult patients from primary care: demographic disparities and their relationship to HMO insurance. J Fam Pract. 1997;45(1):47-53.
Franks, P., & Clancy, C. M. (1997). Referrals of adult patients from primary care: demographic disparities and their relationship to HMO insurance. The Journal of Family Practice, 45(1), 47-53.
Franks P, Clancy CM. Referrals of Adult Patients From Primary Care: Demographic Disparities and Their Relationship to HMO Insurance. J Fam Pract. 1997;45(1):47-53. PubMed PMID: 9228914.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Referrals of adult patients from primary care: demographic disparities and their relationship to HMO insurance. AU - Franks,P, AU - Clancy,C M, PY - 1997/7/1/pubmed PY - 1997/7/1/medline PY - 1997/7/1/entrez SP - 47 EP - 53 JF - The Journal of family practice JO - J Fam Pract VL - 45 IS - 1 N2 - BACKGROUND: Increasing enrollment in managed care organizations and dissatisfaction with policies to restrict direct access to specialists have intensified interest in referrals from primary care physicians to specialists. We examined the associations of demographic factors and insurance with referrals of adult patients by primary care physicians. METHODS: Office visits of adult patients to primary care physicians (general practitioners, family physicians, and internists) reported in the National Ambulatory Care Survey for the years 1985 through 1992 were used to examine referrals by primary care physicians. Regression analyses were adjusted for patient factors (age, sex, race, insurance, case mix, diagnostic category, new problem or not, new patient or not, and visit length), physician factors (age, sex, specialty, and degree of specialization), and practice factors (proportion of HMO patients, rural location, region, and study year). RESULTS: Overall, 4.5% of patients were referred compared with 7.5% of patients with HMO insurance. After adjustment, an increased likelihood of referral was associated with being a male patient, having fewer medications prescribed, not being seen before for the presenting problem, a longer visit, less physician specialization, seeing a female physician, seeing an internist, and seeing a physician with a greater proportion of patients with HMO insurance. Among patients with HMO insurance, no gender disparity in referral rate was observed, and patients who also had Medicaid or Medicare insurance were more likely to be referred. CONCLUSIONS: Male patients are more likely to be referred. HMO insurance may reduce this gender disparity and increase the access of patients with Medicaid and Medicare to specialty care. SN - 0094-3509 UR - https://www.unboundmedicine.com/medline/citation/9228914/Referrals_of_adult_patients_from_primary_care:_demographic_disparities_and_their_relationship_to_HMO_insurance_ L2 - https://medlineplus.gov/healthinsurance.html DB - PRIME DP - Unbound Medicine ER -