Primary Care Physician Specialty Referral Decision Making: Patient, Physician, and Health Care System Determinants

Christopher B. Forrest, Paul A. Nutting, Sarah von Schrader, Charles Rohde and Barbara Starfield
Additional contact information
Christopher B. Forrest: Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health, Baltimore, MDcforrest@jhsph.edu
Paul A. Nutting: Center for Research Strategies and the Department of Family Medicine, University of Colorado, Denver
Sarah von Schrader: Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City
Charles Rohde: Department of Biostatistics Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Barbara Starfield: Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Medical Decision Making, 2006, vol. 26, issue 1, 76-85

Abstract: Purpose. To examine the effects of patient, physician, and health care system characteristics on primary care physicians’ (PCPs’) specialty referral decision making. Methods. Physicians (n = 142) and their practices (n = 83) located in 30 states completed background questionnaires and collected survey data for all patient visits (n = 34,069) made during 15 consecutive workdays. The authors modeled the occurrence of any specialty referral, which occurred during 5.2% of visits, as a function of patient, physician, and health care system structural characteristics. A subanalysis was done to examine determinants of referrals made for discretionary indications (17% of referrals), operationalized as problems commonly managed by PCPs, high level of diagnostic and therapeutic certainty, low urgency for specialist involvement, and cognitive assistance only requested from the specialist. Results. Patient characteristics had the largest effects in the any-referral model. Other variables associated with an increased risk of referral included PCPs with less tolerance of uncertainty, larger practice size, health plans with gatekeeping arrangements, and practices with high levels of managed care. The risk of a referral being made for discretionary reasons was increased by capitated primary care payment, internal medicine specialty of the PCP, high concentration of specialists in the community, and higher levels of managed care in the practice. Conclusions. PCPs’ referral decisions are influenced by a complex mix of patient, physician, and health care system structural characteristics. Factors associated with more discretionary referrals may lower PCPs’ thresholds for referring problems that could have been managed in their entirety within primary care settings.

Keywords: referral-consultation; primary care; managed care; medical decision making; uninsured (search for similar items in EconPapers)
Date: 2006
References: View complete reference list from CitEc
Citations: View citations in EconPapers (9)

Downloads: (external link)
https://journals.sagepub.com/doi/10.1177/0272989X05284110 (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:26:y:2006:i:1:p:76-85

DOI: 10.1177/0272989X05284110

Access Statistics for this article

More articles in Medical Decision Making
Bibliographic data for series maintained by SAGE Publications ().