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Variation in general practitioner referral of patients with arterial disease
S A J Grimble1, C Button, T R Magee
1Departments of Surgery, Royal Berkshire Hospital, Reading, UK.
Insights
Vascular referral patterns for arterial disease differ significantly between UK regions and change over time. These variations impact the planning and delivery of essential vascular services.
Area of Science:
- Vascular Surgery
- Health Services Research
Background:
- General practitioner (GP) referral patterns for arterial disease are crucial for timely patient management.
- Understanding regional variations in these patterns is essential for effective healthcare planning.
Purpose of the Study:
- To compare arterial disease referral patterns among general practitioners in two distinct UK regions.
- To assess changes in referral practices over time within one region.
Main Methods:
- A postal questionnaire survey was administered to general practitioners (GPs) in West Berkshire (1993 and 2000) and Llantrisant (2000).
- The survey focused on referral patterns for various arterial disease presentations, including claudication and aortic aneurysms.
Main Results:
- Referral likelihood for conditions like claudication and aortic aneurysms increased significantly in West Berkshire between 1993 and 2000.
- Significant differences in referral rates for intermittent claudication were observed between West Berkshire and Llantrisant in 2000.
- GP attitudes towards abdominal aortic aneurysm (AAA) screening varied significantly between the two areas, with higher perceived value in Llantrisant.
- Referral rates to regional vascular centers differed markedly between the two areas in 2000.
Conclusions:
- Vascular referral patterns demonstrate temporal changes and geographic variability.
- These observed differences have significant implications for the strategic planning and resource allocation of vascular services.
Aim:
To compare patterns of referral for arterial disease in two areas in the UK.
Methods:
A postal questionnaire was used to survey general practitioner (GP) referral patterns for arterial disease. Questionnaires were sent to West Berkshire GPs in 1993 and 2000 and to Llantrisant GPs in 2000.
Results:
A 70-year-old man with claudication at half a mile and an 80-year-old man with claudication at half a mile or 100 m were significantly more likely to be referred (P < 0.001) in West Berkshire in 2000 compared with 1993. This referral change also applied to an 80-year-old man with an aortic aneurysm who was more likely to be referred in 2000 (P < 0.01). Patients with gradual onset of rest pain were more likely to be referred urgently or as an emergency in 2000 (P < 0.05). When comparing the two areas in 2000, significant differences emerged in the likelihood of referring patients with intermittent claudication. Scepticism continues towards the value of AAA screening in West Berkshire with only about two-thirds of GPs thinking that it was of value. On the other hand in Llantrisant, 94% of GPs thought AAA screening was valuable (P < 0.001). There was a significant decrease in the number of GPs who felt that they would refer patients directly to a regional vascular centre in West Berkshire between the two time periods (P < 0.001). There was a difference in likelihood of referral to regional centres between the two areas in 2000 (33% versus 6%, P < 0.001).
Conclusions:
Vascular referral patterns change with time and vary from one area to another. This has implications for planning vascular services.