Factors associated with the decision to refer patients with anxiety disorders or sexual dysfunction

The decision to refer patients to outside agencies is a complex one, seemingly related to patient, doctor and practice variables. Although there is a wide variation in referral rates between doctors, attempts to specify relevant demographic characteristics have been largely unsuccessful. The present study involves an examination of the factors which general practitioners report would affect their decision to refer, or not refer, patients portrayed in four case studies, two with anxiety disorders and two with sexual dysfunction. The results suggest that very different variables may be relevant for apparently similar conditions. The factor which most consistently distinguished between frequent and infrequent referers was the time they believed was required for treatment, but perceived responsibility for treatment was also important. Seventy per cent of the variance in referral decisions for sexual dysfunction but only 26% of the variance for anxiety disorders was accounted for by such variables as perceived expertise, time required for treatment and confidence in agencies. Demographic factors, such as age and level of training, were not associated with referral behaviour. Suggestions for further research, especially to do with the processes involved in decision making, are outlined.