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Is choice of general practitioner important for patients having coronary artery investigations?
1Department of Epidemiology and Public Health, Queen's University of Belfast.
Insights
General practitioners (GPs) decisions on revascularisation referral for stable angina patients are influenced by sociodemographic factors, not just clinical need. This may lead to unequal access to treatments like angiography for certain patient groups.
Area of Science:
- Cardiology
- Health Services Research
- General Practice
Background:
- Stable angina management often involves revascularisation assessment.
- General practitioners (GPs) play a crucial role in referring patients for these assessments.
Purpose of the Study:
- To investigate if patient sociodemographic characteristics influence GPs' referral decisions for revascularisation.
- To identify potential biases in the referral process for stable angina patients.
Main Methods:
- A postal questionnaire survey was conducted among 962 GPs in Northern Ireland.
- The survey examined the relationship between referral decisions and patient age, sex, employment, home circumstances, smoking, and obesity.
Main Results:
- Most GPs reported neutrality towards most sociodemographic factors in referral decisions.
- However, younger patients were more likely to be referred, while smokers and obese patients were less likely.
- Employed patients and those with dependents were more likely to be referred, irrespective of clinical need.
Conclusions:
- GPs' referral decisions for revascularisation are not solely based on clinical criteria.
- Sociodemographic factors significantly influence these decisions, potentially leading to inequitable access to revascularisation services.
- This highlights a need to address potential biases in patient referral pathways.
Objective:
To determine whether particular sociodemographic characteristics of patients with stable angina affected their general practitioners' (GPs') decisions to refer them for revascularisation assessment.
Design:
Postal questionnaire survey.
Setting:
Collaborative survey by the departments of public health medicine in each of the four health boards in Northern Ireland, serving a total population of 1.5 million.
Subjects:
All (962) GPs.
Main Measures:
The relation between GPs' referral decisions and patients' age, sex, employment status, home circumstances, smoking habits, and obesity.
Results:
541 GPs replied (response rate 56%). Most were "neutral" towards a patient's sex (428, 79%), weight (331, 61%), smoking habit (302, 56%), employment status (431, 80%), and home circumstances (408, 75%) in making decisions about referral. In assigning priority for surgery most were neutral towards the patient's sex (459, 85%), employment status (378, 70%), and home circumstances (295, 55%). However, most GPs (518, 95%) said that younger patients were more likely to be referred, and a significant minority were less likely to refer patients who smoked (202, 37%) and obese patients (175, 32%) and more likely to refer employed patients (97, 18%) and those with dependents (117, 22%) (compared with patients with otherwise comparable clinical characteristics); these views paralleled the priority which GPs assigned these groups. The stated likelihood of referral of young patients was independent of the GPs' belief in ability to benefit from revascularisation, but propensity to refer and perception of benefit were significantly associated for all other patient characteristics.
Conclusion:
GPs' weighting of certain characteristics in reaching decisions about referral for angiography is not uniform and may contribute to unequal access to revascularisation services for certain patient groups.