Predictors of patient referrals by primary care residents to specialty care clinics.
OBJECTIVE
Physician referral patterns significantly impact costs, quality of care, and access to the health system. This paper examines factors predictive of patient referrals to specialists by primary care residents.


METHODS
New adult patients (n=509) were randomly assigned to primary care residents at a university medical center. Patient referrals to specialists were monitored for 1 year of care. Self-reported patient health status, sociodemographic information, number of primary care visits, and physician practice style behaviors were incorporated into statistical analyses predicting specialty referrals.


RESULTS
Patients who were referred to specialty care were significantly older, had poorer physical health, and saw their primary care physicians more often than patients who were not referred. Patients were most frequently referred to surgical specialty clinics. After controlling for physical health status, gender, and age, more frequent visits to a primary care resident physician who had a technically oriented style of care was associated with a greater total number of specialty clinic referrals.


CONCLUSIONS
Patient variables, as well as physician practice style, have an important impact on the specialty referral process. Although the appropriateness of referrals was not evaluated, these findings have implications for health care delivery.
Bertakis
K D
KD
Department of Family and Community Medicine, University of California, Davis, Sacramento 95817, USA. Kdbertakis@ucdavis.edu
Callahan
E J
EJ
Azari
R
R
Robbins
J A
JA
D000328:Adult; D002140:California; D005194:Family Practice / Q000193:education* / Q000706:statistics & numerical data; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D008511:Medicine; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013038:Specialization