title: A qualitative study exploring variations in GPs' out-of-hours referrals to hospital.
abstract: BACKGROUND
  There is evidence of significant variations in hospital referral rates for GPs working in out-of-hours care.
  
  
  OBJECTIVE
  To explain why there are marked variations in hospital referral rates for GPs working in out-of-hours care.
  
  
  METHODS
  In depth, face-to-face interviews with a purposive sample of GPs with different out-of-hours referral rates.
  
  
  METHODS
  Bristol, UK.
  
  
  METHODS
  GPs were selected according to their rate of out-of-hours hospital referral. They were classified as high, medium, or low referrers. Five interviews were carried out with GPs from each of the three categories.
  
  
  RESULTS
  High referring GPs are typically cautious and believe it is better to admit if in doubt. They express anxiety about the consequences of a decision not to admit, both for the patient and for themselves. They hold negative attitudes towards alternatives to hospital admission. Low referrers were more confident about their decisions and less often worried afterwards. Low referrers were positive about alternatives to hospital admission and described themselves as able to resist pressures from family or carers to have someone admitted. Low referrers also see hospitals as places to be avoided and viewed their goal as preventing an admission.
  
  
  CONCLUSIONS
  Educational programmes need to be developed to improve GPs' judgements of their competences and to build appropriate levels of confidence.
authors.affiliation: University of Bristol, Bristol. m.w.calnan@kent.ac.uk
authors.forename: Michael
authors.initials: M
authors.lastname: Calnan
authors.forename: Sarah
authors.initials: S
authors.lastname: Payne
authors.forename: Terry
authors.initials: T
authors.lastname: Kemple
authors.forename: Michael
authors.initials: M
authors.lastname: Rossdale
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ingram
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D003657:Decision Making; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education / Q000458:organization & administration; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011364:Professional Practice; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data*