title: Factors associated with referrals for obstructive sleep apnea evaluation among community physicians.
abstract: OBJECTIVE
  This study assessed knowledge and attitudes toward obstructive sleep apnea (OSA) among community physicians and explored factors that are associated with referrals for OSA evaluation.
  
  
  METHODS
  Medical students and residents collected data from a convenience sample of 105 physicians practicing at community-based clinics in a large metropolitan area. Average age was 48 ± 14 years; 68% were male, 70% black, 24% white, and 6% identified as "other." Physicians completed the Obstructive Sleep Apnea Knowledge and Attitudes questionnaire.
  
  
  RESULTS
  The average year in physician practice was 18 ± 19 years. Of the sample, 90% reported providing care to black patients. The overall OSA referral rate made by physicians was 75%. OSA knowledge and attitudes scores ranged from 5 to 18 (mean = 14 ± 2) and from 7 to 20 (mean = 13 ± 3), respectively. OSA knowledge was associated with white race/ ethnicity (rp = 0.26, p < 0.05), fewer years in practice (rp = -0.38, p < 0.01), patients inquiring about OSA (rp = 0.31, p < 0.01), and number of OSA referrals made for OSA evaluation (rp = 0.30, p < 0.01). Positive attitude toward OSA was associated with patients inquiring about OSA (rp = 0.20, p < 0.05). Adjusting for OSA knowledge and attitudes showed that physicians whose patients inquired about OSA were nearly 10 times as likely to make a referral for OSA evaluation (OR = 9.38, 95% CI: 2.32-38.01, p < 0.01).
  
  
  CONCLUSIONS
  Independent of physicians' knowledge and attitudes toward obstructive sleep apnea, the likelihood of making a referral for obstructive sleep apnea evaluation was influenced by whether patients inquired about the condition.
authors.affiliation: Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU School of Medicine, New York, NY.
authors.forename: Natasha J
authors.initials: NJ
authors.lastname: Williams
authors.affiliation: Department of Physiology, Pharmacology and Neuroscience, The Sophie Davis School of Biomedical Education, The City College of New York, New York, NY.
authors.forename: João V
authors.initials: JV
authors.lastname: Nunes
authors.affiliation: Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU School of Medicine, New York, NY.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Zizi
authors.affiliation: Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN.
authors.forename: Kola
authors.initials: K
authors.lastname: Okuyemi
authors.affiliation: Department of Biobehavioral Health, Penn State University, University Park, PA.
authors.forename: Collins O
authors.initials: CO
authors.lastname: Airhihenbuwa
authors.affiliation: Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU School of Medicine, New York, NY.
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.affiliation: Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU School of Medicine, New York, NY.
authors.forename: Girardin
authors.initials: G
authors.lastname: Jean-Louis
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: attitudes; community physician; knowledge; obstructive sleep apnea; referral