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Family physician referrals to specialists are influenced by patient factors like age and chronic conditions, as well as practice location. This study establishes methods for analyzing referral rates using electronic medical record data.

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Area of Science:

  • Health Services Research
  • Primary Care Medicine
  • Epidemiology

Background:

  • Referrals from family physicians (FPs) to specialists are critical junctures in patient care.
  • Electronic medical record (EMR) databases offer valuable data for studying referral patterns.
  • Advanced statistical methods are now available for analyzing complex healthcare data.

Purpose of the Study:

  • To develop and apply methodology for calculating specialist referral rates from FPs.
  • To utilize the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) EMR database for this analysis.

Main Methods:

  • Retrospective cohort study design.
  • Mixed-effects and multi-level negative binomial regression modeling.
  • Analysis of 87,258 patients from 2007-2012, examining patient and practice-level factors.

Main Results:

  • Average annual referrals were 0.26 for males and 0.31 for females.
  • Referrals significantly increased with female sex, older age, more FP visits, and more chronic conditions.
  • Patient characteristics accounted for 86% of referral variance, while practice characteristics accounted for 14%.

Conclusions:

  • Both patient and practice-level factors significantly impact referral rates.
  • The established methodology is applicable to future health services research using count data.
  • The CPCSSN database is a valuable resource for tracking Canadian referral patterns over time.