دورية أكاديمية
The impact of variation in out-of-hours doctors' referral practices: a Norwegian registry-based observational study.
| العنوان: | The impact of variation in out-of-hours doctors' referral practices: a Norwegian registry-based observational study. |
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| المؤلفون: | Blinkenberg J; National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Årstadveien 17, 5009 Bergen, Norway.; Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway., Hetlevik Ø; Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway., Sandvik H; National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Årstadveien 17, 5009 Bergen, Norway., Baste V; National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Årstadveien 17, 5009 Bergen, Norway., Hunskaar S; National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Årstadveien 17, 5009 Bergen, Norway.; Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway. |
| المصدر: | Family practice [Fam Pract] 2023 Dec 22; Vol. 40 (5-6), pp. 728-736. |
| نوع المنشور: | Observational Study; Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: England NLM ID: 8500875 Publication Model: Print Cited Medium: Internet ISSN: 1460-2229 (Electronic) Linking ISSN: 02632136 NLM ISO Abbreviation: Fam Pract Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Oxford : Oxford University Press, [c1983- |
| مواضيع طبية MeSH: | After-Hours Care*, Humans ; Primary Health Care ; Referral and Consultation ; Registries ; Norway |
| مستخلص: | Background: In a gatekeeping system, the individual doctor's referral practice is an important factor for hospital activity and patient safety. Objective: The aim of the study was to investigate the variation in out-of-hours (OOH) doctors' referral practice, and to explore these variations' impact on admissions for selected diagnoses reflecting severity, and 30-day mortality. Methods: National data from the doctors' claims database were linked with hospital data in the Norwegian Patient Registry. Based on the doctor's individual referral rate adjusted for local organizational factors, the doctors were sorted into quartiles of low-, medium-low-, medium-high-, and high-referral practice. The relative risk (RR) for all referrals and for selected discharge diagnoses was calculated using generalized linear models. Results: The OOH doctors' mean referral rate was 110 referrals per 1,000 consultations. Patients seeing a doctor in the highest referring practice quartile had higher likelihood of being referred to hospital and diagnosed with the symptom of pain in throat and chest, abdominal pain, and dizziness compared with the medium-low quartile (RR 1.63, 1.49, and 1.95). For the critical conditions of acute myocardial infarction, acute appendicitis, pulmonary embolism, and stroke, we found a similar, but weaker, association (RR 1.38, 1.32, 1.24, and 1.19). The 30-day mortality among patients not referred did not differ between the quartiles. Conclusions: Doctors with high-referral practice referred more patients who were later discharged with all types of diagnoses, including serious and critical conditions. With low-referral practice, severe conditions might have been overlooked, although the 30-day mortality was not affected. (© The Author(s) 2023. Published by Oxford University Press.) |
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| معلومات مُعتمدة: | National Centre for Emergency Primary Health Care; Department of Global Public Health and Primary Care |
| فهرسة مساهمة: | Keywords: emergencies; gatekeeping; general practitioners; out-of-hours medical care; patient admission; referral and consultation Local Abstract: [plain-language-summary] A major task for primary care doctors working out-of-hours (OOH) is to refer patients in need of acute specialized care to hospital. Acute referrals capture the major dilemma of not missing critically ill patients without overloading the hospital capacity. There is a known variation in referral practice between OOH doctors, and here we asked what impact this variation has for OOH patients. We divided OOH doctors in Norway into 4 groups according to their referral practice low, medium-low, medium-high, and high. Low had few referrals as a proportion of the total consultations, while the high group had many. If the patient saw a doctor in the high-referral group, there was an increased likelihood to be referred to hospital and given a symptom diagnosis, indicating that no severe disease was revealed. High-referral practice therefore may lead to more avoidable admissions. However, we also found the same but weaker effect for some critical conditions (heart infarction, acute appendicitis, pulmonary embolism, and stroke). Therefore, a low-referral practice may increase the risk of critical conditions being overlooked. These aspects of referral practice variation should be taken into consideration and call for strengthening the OOH framework for decision making regarding acute referrals. |
| تواريخ الأحداث: | Date Created: 20230221 Date Completed: 20231225 Latest Revision: 20240130 |
| رمز التحديث: | 20240131 |
| مُعرف محوري في PubMed: | PMC10745277 |
| DOI: | 10.1093/fampra/cmad014 |
| PMID: | 36801994 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1460-2229 |
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| DOI: | 10.1093/fampra/cmad014 |