HOW VALUABLE IS FEEDBACK OF INFORMATION ON HOSPITAL REFERRAL PATTERNS

Objectives-To determine general practitioners' responses to and explan ations for variation in rates of referral to hospital and how feedback of data on rates of referral could be used to facilitate practices in auditing their own referral behaviour. Design-Visits by audit facilit ators to general practices after feedback of details of rates of refer ral to hospital derived from annual reports in general practice. Setti ng-92 general practices in East Anglia. Results-General practitioners judged that access to specialist care, the individual skill of general practitioners, patient demand, and fear of litigation were major dete rminants of referral behaviour. Because there was widespread scepticis m about the accuracy of the data on which the feedback was based and b ecause there is no clear relation between rates of referral and qualit y of care, it was extremely difficult to encourage doctors to use the feedback as a basis for auditing their own hospital referrals. Conclus ion-If general practitioners are to contribute meaningfully to monitor ing future changes in referral patterns it will be essential to develo p reliable information systems in which doctors have confidence. Furth ermore, audits need to be based on analysis of clinical cases rather t han on rates of referral.