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Gatekeeping and referrals to cardiologists: general practitioners' views on interactive communications
Steinar Bjornsson1, Johann A Sigurdsson, Alma Eir Svavarsdottir
1Efstaleiti Primary Health Care Centre, Reykjavik, Iceland. steinarbjorns@gmail.com
Insights
Icelandic general practitioners (GPs) found the reintroduced specialist referral system beneficial, enhancing patient care through improved communication. Geographical location influenced the perceived value of referrals.
Area of Science:
- Health Services Research
- General Practice
- Cardiology
Background:
- Iceland discontinued mandatory specialist referrals in 1984.
- A 2006 policy reintroduced referrals for cardiologist appointments to facilitate cost reimbursement.
- This shift prompted an investigation into general practitioners' (GPs) perspectives on the referral system.
Purpose of the Study:
- To assess general practitioners' attitudes towards the mandatory specialist referral system.
- To explore the professional gains derived from interactive communication between GPs and specialists.
- To evaluate the impact of the reintroduced referral system on information flow and patient benefit.
Main Methods:
- A cross-sectional questionnaire survey was administered to all practicing GPs in Iceland (n=201).
- The survey collected data on referral processes, reasons for referrals, response letter frequency, and GP attitudes.
- Comparisons were made between rural and urban GP responses.
Main Results:
- A 63% response rate was achieved (126 GPs).
- 98% of GPs found specialist report letters helpful; 64% believed the new referral system improved patient care information.
- Significant differences in referral process aspects were observed between rural and urban GPs.
Conclusions:
- The specialist referral system enhances information exchange and communication between general practitioners and specialists, ultimately benefiting patients.
- Geographical location of healthcare facilities plays a role in the perceived value and effectiveness of specialist referrals.
Objective:
Referrals to specialists have not been compulsory in Iceland since 1984. In 2006, referrals were again required for patients to receive reimbursement for part of the cost of appointments with cardiologists. The aim of this study was to explore GPs' attitudes to the referral system and possible professional gain by interactive communications.
Design:
Cross-sectional questionnaire survey. SETTING, SUBJECTS, AND MAIN OUTCOME MEASURES: This is part of a larger study in 2007 on referrals from GPs to cardiologists. A questionnaire was sent to all working GPs in Iceland (n = 201 and responsible for 307 000 inhabitants) regarding the referral process, reasons for referrals, how often a response letter was received, and GPs' attitudes to the referral system. Responses from doctors working in rural areas were compared with those working in Reykjavik and nearby urban areas.
Results:
The response rate was 63% (126 answers). The mean age of participants was 51; 89% were GP specialists and 60% worked in Reykjavik and nearby urban areas. Almost all respondents (98%) thought that report letters from cardiologists were helpful; 64% (95% confidence interval 53-73) thought that the recently introduced referral system did increase useful information that was beneficial to their patients. There was a statistically significant difference between colleagues working in rural areas and those working in Reykjavik and nearby urban areas regarding several aspects of the referral process.
Conclusion:
A referral system increases the flow of information and mutual communications between general practitioners and specialists to the benefit of the patients. The geographical location of the health care centre may be of importance regarding the value of the referrals.
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