title: The 'natural history' of declined outpatient gastroenterology referrals.
abstract: OBJECTIVE
  To evaluate the 'natural history' of outpatients who were referred to the Division of Gastroenterology at the University of Alberta Hospital (Edmonton, Alberta) for gastrointestinal problems and were subsequently declined.
  
  
  METHODS
  Patients were tracked for 12 months after they were referred and declined for the following indications: abdominal pain, rectal bleeding, fecal occult blood test-positive stools and iron deficiency. For each patient, data regarding consultations by other gastroenterologists or surgeons working in the region, clinically relevant diagnoses and the number of gastrointestinal-related x-rays performed were obtained.
  
  
  RESULTS
  Of a total sample size of 230 patients, 110 (47.8%) were seen by another gastroenterologist or surgeon after decline. A significant diagnosis was made in 21 patients (9.1%), which had immediate clinical consequences in 29%. Forty per cent of patients underwent one or more gastointestinal-related x-rays before being declined, which increased to 55% after decline.
  
  
  CONCLUSIONS
  Approximately 50% of declined patients were seen by other gastroenterologists or surgeons in the region. In 9.1% of these patients, a clinically important diagnosis was made, of which one-quarter had immediate medical consequences.
authors.affiliation: Leider University, Leiden, The Netherlands.
authors.forename: Emelie M
authors.initials: EM
authors.lastname: de Boer
authors.forename: David
authors.initials: D
authors.lastname: Pincock
authors.forename: Sander Veldhuyzen
authors.initials: SV
authors.lastname: van Zanten
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta; D000553:Ambulatory Care / Q000458:organization & administration; D015331:Cohort Studies; D005260:Female; D005762:Gastroenterology / Q000458:organization & administration*; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D012017:Referral and Consultation / Q000458:organization & administration*; D013997:Time Factors; D014850:Waiting Lists