Compliance with referrals to medical specialist care: Patient and general practice determinants: a cross-sectional study

C.E. van Dijk, Judith D de Jong, Robert A Verheij, Tessa Jansen, Joke C Korevaar, D.H. de Bakker

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Background: 

In a gatekeeper system, primary care physicians and patients jointly decide whether or not medical specialist care is needed. However, it is the patient who decides to actually use the referral. Referral non-compliance could delay diagnosis and treatment. The objective of this study was to assess patient compliance with a referral to medical specialist care and identify patient and practice characteristics that are associated with it.

Methods: 

Observational study using data on 48,784 referrals to medical specialist care derived from electronic medical records of 58 general practices for the period 2008-2010. Referral compliance was based on claims data of medical specialist care. Logistic multilevel regression analyses were conducted to determine associations between patient and general practice characteristics and referral compliance.

Results: 

In 86.6 % of the referrals, patients complied. Patient and not practice characteristics were significantly associated with compliance. Patients from deprived urban areas and patients aged 18-44 years were less likely to comply, whereas patients aged 65 years and older were more likely to comply.

Conclusion: 

About 1 in 8 patients do not use their referral. These patients may not receive adequate care. Demographic and socio-economic factors appear to affect compliance. The results of this study may be used to make general practitioners more aware that some patients are more likely to be noncompliant with referrals.

Original languageEnglish
JournalBMC Family Practice
Volume17
Issue number1
DOIs
Publication statusPublished - 2016

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General Practice
Cross-Sectional Studies
Compliance
Electronic Health Records
Primary Care Physicians
General Practitioners
Logistic Models

Cite this

van Dijk, C.E. ; de Jong, Judith D ; Verheij, Robert A ; Jansen, Tessa ; Korevaar, Joke C ; de Bakker, D.H. / Compliance with referrals to medical specialist care : Patient and general practice determinants: a cross-sectional study. In: BMC Family Practice. 2016 ; Vol. 17, No. 1.
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title = "Compliance with referrals to medical specialist care: Patient and general practice determinants: a cross-sectional study",
abstract = "Background: In a gatekeeper system, primary care physicians and patients jointly decide whether or not medical specialist care is needed. However, it is the patient who decides to actually use the referral. Referral non-compliance could delay diagnosis and treatment. The objective of this study was to assess patient compliance with a referral to medical specialist care and identify patient and practice characteristics that are associated with it.Methods: Observational study using data on 48,784 referrals to medical specialist care derived from electronic medical records of 58 general practices for the period 2008-2010. Referral compliance was based on claims data of medical specialist care. Logistic multilevel regression analyses were conducted to determine associations between patient and general practice characteristics and referral compliance.Results: In 86.6 {\%} of the referrals, patients complied. Patient and not practice characteristics were significantly associated with compliance. Patients from deprived urban areas and patients aged 18-44 years were less likely to comply, whereas patients aged 65 years and older were more likely to comply.Conclusion: About 1 in 8 patients do not use their referral. These patients may not receive adequate care. Demographic and socio-economic factors appear to affect compliance. The results of this study may be used to make general practitioners more aware that some patients are more likely to be noncompliant with referrals.",
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Compliance with referrals to medical specialist care : Patient and general practice determinants: a cross-sectional study. / van Dijk, C.E.; de Jong, Judith D; Verheij, Robert A; Jansen, Tessa; Korevaar, Joke C; de Bakker, D.H.

In: BMC Family Practice, Vol. 17, No. 1, 2016.

Research output: Contribution to journalArticleScientificpeer-review

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AU - van Dijk, C.E.

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AU - Verheij, Robert A

AU - Jansen, Tessa

AU - Korevaar, Joke C

AU - de Bakker, D.H.

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N2 - Background: In a gatekeeper system, primary care physicians and patients jointly decide whether or not medical specialist care is needed. However, it is the patient who decides to actually use the referral. Referral non-compliance could delay diagnosis and treatment. The objective of this study was to assess patient compliance with a referral to medical specialist care and identify patient and practice characteristics that are associated with it.Methods: Observational study using data on 48,784 referrals to medical specialist care derived from electronic medical records of 58 general practices for the period 2008-2010. Referral compliance was based on claims data of medical specialist care. Logistic multilevel regression analyses were conducted to determine associations between patient and general practice characteristics and referral compliance.Results: In 86.6 % of the referrals, patients complied. Patient and not practice characteristics were significantly associated with compliance. Patients from deprived urban areas and patients aged 18-44 years were less likely to comply, whereas patients aged 65 years and older were more likely to comply.Conclusion: About 1 in 8 patients do not use their referral. These patients may not receive adequate care. Demographic and socio-economic factors appear to affect compliance. The results of this study may be used to make general practitioners more aware that some patients are more likely to be noncompliant with referrals.

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