REFERRALS OF PATIENTS BY FAMILY PHYSICIANS TO CONSULTANTS - A SURVEY OF THE ISRAELI-FAMILY-PRACTICE-RESEARCH-NETWORK

Objective. We aimed to analyse factors influencing referral of patient s by primary care physicians to specialist consultants at the beginnin g of the era of direct access to specialists in Israel. Methods. We ca rried out a study of referrals by family physicians to specialists ove r a continuous period of 3 months. Twenty-four certified family physic ians filled in a questionnaire detailing referrals during the study pe riod. All patients were referred for consultation to a specialist at r egional speciality clinics or hospital out-patient departments. Result s. Ten physicians met the study conditions. In 1140 of 10 896 (10.5%) visits, patients were referred to specialist consultants. The percenta ge of referral ranged from 7.4 to 15.9%. The difference between the ph ysicians with the lowest and highest rates of referral was statistical ly significant (P < 0.0001). The variance in referral rates was not ex plained by significant differences in physician or practice variables. The types of specialists to whom the most referrals were made were or thopaedic surgeons, ophthalmologists, dermatologists, ear, nose and th roat, general surgeons and plastic surgeons. There was a significant c orrelation between the type of specialist and the age of the patient. Older patients were referred more frequently to urologists, cardiologi sts and ophthalmologists, while younger patients were referred more fr equently to ear, nose and throat specialists and gynaecologists (P < 0 .01). Conclusions. The results of this study can be used as an aid for decision makers in the health services for determining policy. Direct access to some specialties might be appropriate, but not to all. Adop tion of a policy based on these findings could lead to reduced health care costs by reducing the burden on hospital emergency rooms. It migh t also increase patient satisfaction in that the patients will have gr eater freedom of choice. On the other hand, more appropriate training of family physicians and more extensive self-and peer-quality assuranc e will increase the primary physician's knowledge and ability to diagn ose and treat a broad range of problems and improve the level of care.