Recognition of patient referral desires in an academic managed care plan frequency, determinants, and outcomes

Albertson, Gail A.; Lin, C. T.; Kutner, Jean; Schilling, Lisa M.; Anderson, Susan N.; Anderson, Robert J.; Albertson, G A; Kutner, J; Schilling, L M; Anderson, S N; Anderson, R J
April 2000
JGIM: Journal of General Internal Medicine;Apr2000, Vol. 15 Issue 4, p242
Academic Journal
journal article
Objective: To determine the frequency and determinants of provider nonrecognition of patients' desires for specialist referral.Design: Prospective study.Setting: Internal medicine clinic in an academic medical center providing primary care to patients enrolled in a managed care plan.Participants: Twelve faculty internists serving as primary care providers (PCPs) for 856 patient visits.Measurements and Main Results: Patients were given previsit and postvisit questionnaires asking about referral desire and visit satisfaction. Providers, blinded to patients' referral desire, were asked after the visit whether a referral was discussed, who initiated the referral discussion, and whether the referral was indicated. Providers failed to discuss referral with 27% of patients who indicated a definite desire for referral and with 56% of patients, who indicated a possible desire for referral. There was significant variability in provider recognition of patient referral desire. Recognition is defined as the provider indicating that a referral was discussed when the patient marked a definite or possible desire for referral. Provider recognition improved significantly (P <.05), when the patient had more than one referral desire, if the patient or a family member was a health care worker and when the patient noted a definite desire versus a possible desire for referral. Patients were more likely (P <.05) to initiate a referral discussion when they had seen the PCP previously and had more than one referral desire. Of patient-initiated referral requests, 14% were considered "not indicated" by PCPs. Satisfaction with care did not differ in patients with a referral desire that were referred and those that were nor referred.Conclusions: These PCPs frequently failed to explicitly recognize patients' referral desires. Patients were more likely to initiate discussions of a referral desire when they saw their usual PCP and had more than a single referral desire.


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