title: Referring patients to specialists: a structured vignette survey of Australian and British GPs.
abstract: BACKGROUND
  In Australia and in the United Kingdom (UK) access to specialists is sanctioned by General Practitioners (GPs). It is important to understand how practitioners determine which patients warrant referral.
  
  
  METHODS
  A self-administered structured vignette postal survey of General Practitioners in Western Australia and the United Kingdom. Sixty-four vignettes describing patients with colorectal symptoms were constructed encompassing six clinical details. Nine vignettes, chosen at random, were presented to each individual. Respondents were asked if they would refer the patient to a specialist and how urgently. Logistic regression and parametric tests were used to analyse the data
  
  
  RESULTS
  We received 260 completed questionnaires. 58% of 'cancer vignettes' were selected for 'urgent' referral. 1632/2367 or 69% of all vignettes were selected for referral. After adjusting for clustering the model suggests that 38.4% of the variability is explained by all the clinical variables as well as the age and experience of the respondents. 1012 or 42.8 % of vignettes were referred 'urgently'. After adjusting for clustering the data suggests that 31.3 % of the variability is explained by the model. The age of the respondents, the location of the practice and all the clinical variables were significant in the decision to refer urgently.
  
  
  CONCLUSIONS
  GPs' referral decisions for patients with lower bowel symptoms are similar in the two countries. We question the wisdom of streaming referrals from primary care without a strong evidence base and an effective intervention for implementing guidelines. We conclude that implementation must take into account the profile of patients but also the characteristics of GPs and referral policies.
authors.affiliation: Western Australian Centre for Cancer and Palliative Care, Curtin University of Technology, Perth Western Australia, Australia. m.jiwa@curtin.edu.au
authors.forename: Moyez
authors.initials: M
authors.lastname: Jiwa
authors.forename: Michael
authors.initials: M
authors.lastname: Gordon
authors.forename: Hayley
authors.initials: H
authors.lastname: Arnet
authors.forename: Hooi
authors.initials: H
authors.lastname: Ee
authors.forename: Max
authors.initials: M
authors.lastname: Bulsara
authors.forename: Brigitte
authors.initials: B
authors.lastname: Colwell
mesh_terms: D000328:Adult; D001315:Australia; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003657:Decision Making; D005194:Family Practice / Q000193:education / Q000592:standards*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D012655:Self-Evaluation Programs; D011795:Surveys and Questionnaires; D006113:United Kingdom