Reasons for outpatient referrals from generalists to specialists

Martin T. Donohoe, Richard L Kravitz, David B. Wheeler, Ravi Chandra, Alice Chen, Natasha Humphries

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

OBJECTIVE: To determine the relative importance of medical and nonmedical factors influencing generalists' decisions to refer, and of the factors that might avert unnecessary referrals. DESIGN: Prospective survey of all referrals from generalists to subspecialists over a 5-month period. SETTING: University hospital outpatient clinics. PARTICIPANTS: Fifty-seven staff physicians in general internal medicine, family medicine, dermatology, orthopedics, gastroenterology, and rheumatology. MEASUREMENTS AND MAIN RESULTS: For each referral, the generalist rated a number of medical and nonmedical reasons for referral, as well as factors that may have helped avert the referral; the specialist seeing the patient then rated the appropriateness, timeliness, and complexity of the referral. Both physicians rated the potential avoidability of the referral by telephone consultation. Generalists were influenced by a combination of both medical and nonmedical reasons for 76% of the referrals, by only medical reasons in 20%, and by only nonmedical reasons in 3%. In 33% of all referrals, generalists felt that training in simple procedures or communication with a generalist or specialist colleague would have allowed them to avoid referral. Specialists felt that the vast majority of referrals were timely (as opposed to premature or delayed) and of average complexity. Although specialists rated most referrals as appropriate, 30% were rated as possibly appropriate or inappropriate. Generalists and specialists failed to agree on the avoidability of 34% of referrals. CONCLUSIONS: Generalists made most referrals for a combination of medical and nonmedical reasons, and many referrals were considered avoidable. Increasing procedural training for generalists and enhancing informal channels of communication between generalists and subspecialists might result in more appropriate referrals at lower cost.

Original languageEnglish (US)
Pages (from-to)281-286
Number of pages6
JournalJournal of General Internal Medicine
Volume14
Issue number5
DOIs
StatePublished - 1999
Externally publishedYes

Fingerprint

Outpatients
Referral and Consultation
Communication
Hospital Outpatient Clinics
Physicians
Rheumatology
Gastroenterology
Internal Medicine
Dermatology
Telephone
Orthopedics
Medicine
Costs and Cost Analysis

Keywords

  • Generalist
  • Outpatients
  • Referral
  • Specialist

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Reasons for outpatient referrals from generalists to specialists. / Donohoe, Martin T.; Kravitz, Richard L; Wheeler, David B.; Chandra, Ravi; Chen, Alice; Humphries, Natasha.

In: Journal of General Internal Medicine, Vol. 14, No. 5, 1999, p. 281-286.

Research output: Contribution to journalArticle

Donohoe, Martin T. ; Kravitz, Richard L ; Wheeler, David B. ; Chandra, Ravi ; Chen, Alice ; Humphries, Natasha. / Reasons for outpatient referrals from generalists to specialists. In: Journal of General Internal Medicine. 1999 ; Vol. 14, No. 5. pp. 281-286.
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