Variability in GPs' referral rates in Spain.
The purpose of this study is to explore the causes that may influence the variations on referral rates in a sample of 242 general practitioners (GPs) in Spain. We applied Poisson multivariant regression modeling to analyze the role played by different variables related to doctors, patients and practices. The mean referral rate was 6.92 +/- 0.22 with a variant coefficient of 50.6%. The results of the Poisson model showed a statistically significant variation on the following variables: 1) doctor gender; 2) proportion of consultations to the practice made by male patients; 3) proportion of consultations made by patients over 65 years of age; 4) list size, 5) number of doctors in the PCT; 6) number of practice consultations to each doctor per week; 7) accredited practice for VT; 8) location of practice; 9) proportion of outpatient referrals; 10) proportion of private referrals; 11) proportion of emergency referrals; 12) proportion of referrals in which the patient's attitude did not influence the doctor for the referral; 13) proportion of new referrals. The statistical significance for the final model was very high (P < 0.00001). The study draws attention to the influence of some structural characteristics of health care system on the referral rates that could be modified to reduce the number of referrals from Primary to Secondary Care.
García Olmos
L
L
Centro de Salud La Chopera, Alcobendas, Madrid, Spain.
Abraira
V
V
Gervas
J
J
Otero
A
A
Pérez Fernández
M
M
D000068:Accreditation; D000367:Age Factors; D000368:Aged; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D016012:Poisson Distribution; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011365:Professional Practice Location; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012737:Sex Factors; D013030:Spain; D016526:Workload