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Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study.
Montgomery, Anthony J; McGee, Hannah; Shannon, William; Donohoe, John
<p>This article is also available from <a href="http://www.biomedcentral.com">www.biomedcentral.com</a></p> <p>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.</p> <p>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.</p> <p>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).</p> <p>CONCLUSION: The very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition.</p>
Keyword(s): 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
Publication Date:
2006
Type: Journal article
Peer-Reviewed: Yes
Institution: Royal College of Surgeons in Ireland
Citation(s): Montgomery AJ, McGee HM, Shannon W, Donohoe J. Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study. BMC Health Services Research. 2006;6:114.
Publisher(s): BioMed Central
File Format(s): application/pdf
Related Link(s): http://epubs.rcsi.ie/psycholart/31
First Indexed: 2015-07-31 15:35:06 Last Updated: 2018-02-13 07:21:35