title: Regional variation in nonmedical factors affecting family physicians' decisions about referral for consultation.
abstract: OBJECTIVE
  To determine whether there is regional variation in environmental (non-medical) factors affecting referral decisions of family physicians (FPs).
  
  
  METHODS
  Cross-sectional interview survey.
  
  
  METHODS
  Nova Scotia.
  
  
  METHODS
  A random sample of 125 FPs grouped into 1 of 5 functionally defined geographic regions of Nova Scotia (25 in each group). Groupings were based on access to general hospital beds through active staff hospital appointments or to specialist consultants in the community, or both. Participants were personally interviewed on site. No physician refused an interview. In 9 cases the physician indicated that he or she did not fit the profile of the assigned group; the physician was excluded from the study and the next doctor on the list was substituted.
  
  
  METHODS
  The questionnaire was designed to test several hypotheses about factors known to potentially influence decisions about referral. Geographic differences in factors affecting referral and in decisions about 5 hypothetical cases were assessed with the use of significance tests for proportions that were sensitive to specific orders across groups.
  
  
  RESULTS
  Three factors affecting referral showed unequivocal variation across the 5 groups. Access to hospital facilities and remoteness from specialist care, leading to local styles of practice or treatment policies, and the FP's relationship with specialist consultants appeared to be important nonmedical factors affecting referral decisions. For similar case scenarios the physicians living in rural areas would refer only half as often overall as those living in urban areas with tertiary care hospitals; for some cases, such as a severe asthma attack, the difference was more than 7-fold.
  
  
  CONCLUSIONS
  Significant differences in nonmedical factors affecting referral, and in referral decisions about hypothetical cases, were found between the groups of FPs. Differences in access to resources, creating local styles of practice, appeared to explain most of the variation. The results may account for previously observed differences in actual rates of referral for these particular groups.
authors.affiliation: Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS.
authors.forename: G R
authors.initials: GR
authors.lastname: Langley
authors.forename: S
authors.initials: S
authors.lastname: Minkin
authors.forename: J E
authors.initials: JE
authors.lastname: Till
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003657:Decision Making; D005194:Family Practice; D006297:Health Services Accessibility; D006801:Humans; D007400:Interprofessional Relations; D009674:Nova Scotia; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D019035:Rural Health Services; D011795:Surveys and Questionnaires