THE CONSULTATION AND REFERRAL PROCESS - A REPORT FROM NEON

BACKGROUND. Consultation and referral are essential components of the practice of primary care. Despite this, little is known about the fact ors that contribute to the success of a referral. We examined the shor t-term outcomes of communication between family physicians and consult ants during the referral process. METHODS. The study setting was six f amily practice centers in northeastern Ohio. All eligible physicians a t each center participated in data collection by means of a card study . Data was recorded on any patient who received a referral to a physic ian or nonphysician provider during the month of July 1994. One year l ater, referrals were followed up by physician questionnaire. RESULTS. Three hundred nine of 5172 total patients were referred (5.97 referral s per 100 office visits). At follow-up, the family physicians reported that 63% of patients had visited the consultant, 14% had not, and the physician had no knowledge of the actions taken by the other 23%. The referring physician received feedback from the consultant regarding 5 5% of the patients referred. Receipt of feedback was strongly related to communication by the family physician to the consultant at the time of referral. Physicians who received feedback were the most satisfied with communication from the consultant and the care their patient had received. CONCLUSIONS. Primary care physicians can influence the like lihood of receiving feedback from a consultant by initiating communica tion with the consultant. A referral wherein the physicians involved d o not communicate with one another results in physician dissatisfactio n. Primary care physicians must practice strategies to improve the ref erral process.