Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study.

Hdl Handle:
http://hdl.handle.net/10147/95627
Title:
Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study.
Authors:
Montgomery, Anthony J; McGee, Hannah M; Shannon, William; Donohoe, John
Affiliation:
Department of Psychology, Royal College of Surgeons in Ireland-Medical University of Bahrain, PO Box 15503, Manama, Bahrain. amontgomery@rcsi-mub.com
Citation:
Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study. 2006, 6:114 BMC Health Serv Res
Journal:
BMC health services research
Issue Date:
2006
URI:
http://hdl.handle.net/10147/95627
DOI:
10.1186/1472-6963-6-114
PubMed ID:
16970805
Abstract:
BACKGROUND: To understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted. METHOD: Randomly selected general practitioners (N = 51) were interviewed using 32 standardised written patient scenarios to elicit referral strategies. Main outcome measures: General practitioner referral levels and thresholds for patients developing end-stage renal disease; referral routes (nephrologist vs other physicians); influence of patient age, marital status and co-morbidity on referral. RESULTS: Referral levels varied widely with the full range of cases (0-32; median = 15) referred by different doctors after consideration of first laboratory results. Less than half (44%) of cases were referred to a nephrologist. Patient age (40 vs 70 years), marital status, co-morbidity (none vs rheumatoid arthritis) and general practitioner prior specialist renal training (yes or no) did not influence referral rates. Many patients were not referred to a specialist at creatinine levels of 129 micromol/l (47% not referred) or 250 micromol/l (45%). While all patients were referred at higher levels (350 and 480 micromol/l), referral to a nephrologist decreased in likelihood as scenarios became more complex; 28% at 129 micromol/l creatinine; 28% at 250 micromol/l; 18% at 350 micromol/l and 14% at 480 micromol/l. Referral levels and routes were not influenced by general practitioner age, sex or practice location. Most general practitioners had little current contact with chronic renal patients (mean number in practice = 0.7, s.d. = 1.3). CONCLUSION: The very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition.
Language:
en
MeSH:
Age Factors; Creatinine; Decision Making; Factor Analysis, Statistical; Family Practice; Female; Humans; Interviews as Topic; Ireland; Kidney Failure, Chronic; Male; Marital Status; Medicine; Middle Aged; Nephrology; Physician's Practice Patterns; Questionnaires; Referral and Consultation; Renal Dialysis; Specialization; Urology
ISSN:
1472-6963

Full metadata record

DC FieldValue Language
dc.contributor.authorMontgomery, Anthony Jen
dc.contributor.authorMcGee, Hannah Men
dc.contributor.authorShannon, Williamen
dc.contributor.authorDonohoe, Johnen
dc.date.accessioned2010-04-06T10:16:22Z-
dc.date.available2010-04-06T10:16:22Z-
dc.date.issued2006-
dc.identifier.citationFactors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study. 2006, 6:114 BMC Health Serv Resen
dc.identifier.issn1472-6963-
dc.identifier.pmid16970805-
dc.identifier.doi10.1186/1472-6963-6-114-
dc.identifier.urihttp://hdl.handle.net/10147/95627-
dc.description.abstractBACKGROUND: To understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted. METHOD: Randomly selected general practitioners (N = 51) were interviewed using 32 standardised written patient scenarios to elicit referral strategies. Main outcome measures: General practitioner referral levels and thresholds for patients developing end-stage renal disease; referral routes (nephrologist vs other physicians); influence of patient age, marital status and co-morbidity on referral. RESULTS: Referral levels varied widely with the full range of cases (0-32; median = 15) referred by different doctors after consideration of first laboratory results. Less than half (44%) of cases were referred to a nephrologist. Patient age (40 vs 70 years), marital status, co-morbidity (none vs rheumatoid arthritis) and general practitioner prior specialist renal training (yes or no) did not influence referral rates. Many patients were not referred to a specialist at creatinine levels of 129 micromol/l (47% not referred) or 250 micromol/l (45%). While all patients were referred at higher levels (350 and 480 micromol/l), referral to a nephrologist decreased in likelihood as scenarios became more complex; 28% at 129 micromol/l creatinine; 28% at 250 micromol/l; 18% at 350 micromol/l and 14% at 480 micromol/l. Referral levels and routes were not influenced by general practitioner age, sex or practice location. Most general practitioners had little current contact with chronic renal patients (mean number in practice = 0.7, s.d. = 1.3). CONCLUSION: The very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition.-
dc.language.isoenen
dc.subject.meshAge Factors-
dc.subject.meshCreatinine-
dc.subject.meshDecision Making-
dc.subject.meshFactor Analysis, Statistical-
dc.subject.meshFamily Practice-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshInterviews as Topic-
dc.subject.meshIreland-
dc.subject.meshKidney Failure, Chronic-
dc.subject.meshMale-
dc.subject.meshMarital Status-
dc.subject.meshMedicine-
dc.subject.meshMiddle Aged-
dc.subject.meshNephrology-
dc.subject.meshPhysician's Practice Patterns-
dc.subject.meshQuestionnaires-
dc.subject.meshReferral and Consultation-
dc.subject.meshRenal Dialysis-
dc.subject.meshSpecialization-
dc.subject.meshUrology-
dc.titleFactors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study.en
dc.contributor.departmentDepartment of Psychology, Royal College of Surgeons in Ireland-Medical University of Bahrain, PO Box 15503, Manama, Bahrain. amontgomery@rcsi-mub.comen
dc.identifier.journalBMC health services researchen

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