title: Examining the variation in GPs' referral practice: a cross-sectional study of GPs' reasons for referral.
abstract: BACKGROUND
  There is a large variation in referral rates to secondary care among GPs, which is partly unexplained.
  
  
  OBJECTIVE
  To explore associations between reasons for referral to secondary care and patient, GP, and healthcare characteristics.
  
  
  METHODS
  A cross-sectional study in Northern Norway.
  
  
  METHODS
  Data were derived from 44 (42%) of 104 randomly selected GPs between 2008 and 2010. GPs scored the relevance of nine predefined reasons for 595 referrals from 4350 consecutive consultations on a four-level categorical scale. Associations were examined by multivariable ordered and multivariable multilevel logistic regression analyses.
  
  
  RESULTS
  Medical necessity was assessed as a relevant reason in 93% of the referrals, 43.7% by patient preference, 27.5% to avoid overlooking anything, and 14.6% to reassure the patient. The higher the referral rates, the more frequently the GPs referred to avoid overlooking anything. Female GPs referred to reassure the patient and due to perceived deficient medical knowledge significantly more often than male GPs. However, perceived easy accessibility of specialists was significantly less frequently given as a reason for referral by female GPs compared with male GPs. When the GPs scored the referrals to be of lesser medical necessity, male GPs referred significantly more frequently than female GPs to reassure the patient due to patient preference and perceived deficient medical knowledge.
  
  
  CONCLUSIONS
  There are striking differences in reasons for referral between Norwegian male and female GPs and between GPs with high and low referral rates, which reflects difficulties in handling professional uncertainty. Referring to reassure the patients, especially when referrals are less medically necessary, may reflect consideration and acquiescence towards the patients.
authors: Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors: Unni
authors: U
authors: Ringberg
authors: Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors: Nils
authors: N
authors: Fleten
authors: Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors: Olav Helge
authors: OH
authors: Førde
mesh_terms: D000367:Age Factors; D004812:Epidemiologic Methods; D005260:Female; D058006:General Practice / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D057240:Patient Preference; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D063127:Secondary Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors
keywords: general practice; patient preference; referral; uncertainty