title: Otitis media referrals - the general practitioner perspective.
abstract: OBJECTIVE
  Otitis media management involves both primary and specialist health care. The present study used data on GP referrals to estimate the proportion of children with otitis media referred from primary to specialist care, study variation in referral pattern and factors that influence GP behaviour.
  
  
  METHODS
  Data on general practitioners' view on collaborative aspects of specialist health care was collected in a cross-sectional questionnaire survey among all Norwegian GPs in 2004 (N=1633). The outcome of interest was referral routines for otitis media at first visit and at follow-up.
  
  
  RESULTS
  Mean referral for otitis media was 22%, most commonly at follow-up visit. Twenty-seven percent of children with otitis media were sent to ENT departments and 73% to practicing otolaryngologists. Variation in referral pattern among GPs was moderate. GPs with specialty in general medicine had 6% fewer referrals. Separate analysis on referral to practicing otolaryngologists showed that GP work load and availability to practicing specialists increased referral, whereas availability to hospital services reduced the probability.
  
  
  CONCLUSIONS
  In Norway, otitis media management mainly takes place in primary care. Completed specialty in general medicine reduces referrals and non-medical factors influence referral behaviour. We suggest that learning groups may contribute to update knowledge in primary care and fewer referrals to specialists.
authors.affiliation: Institute for Special Needs, University of Oslo, Oslo, Norway. k.j.kvarner@medisin.uio.no
authors.forename: Kari J
authors.initials: KJ
authors.lastname: Kvaerner
authors.forename: Anja B
authors.initials: AB
authors.lastname: Helgaker
mesh_terms: D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D009664:Norway / Q000453:epidemiology; D010033:Otitis Media / Q000453:epidemiology*; D010036:Otolaryngology / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013038:Specialization; D011795:Surveys and Questionnaires