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Area of Science:

  • Primary Care Research
  • Health Services Research
  • General Practice

Background:

  • Primary care systems face challenges due to aging populations and increasing multimorbidity.
  • Shared decision-making (SDM) is crucial for effective treatment planning, especially in complex patient cases.
  • Understanding General Practitioners' (GPs) perceptions of SDM in patient referrals is vital for enhancing health outcomes and patient satisfaction.

Purpose of the Study:

  • To assess international variations in GPs' perceptions of SDM regarding patient referrals.
  • To compare the extent of SDM in GP referrals between gatekeeping and non-gatekeeping healthcare systems.
  • To identify factors influencing GP referral decisions and how these differ across healthcare system types.

Main Methods:

  • Data collected from the QUALICOPC study (Quality and Costs of Primary Care in Europe) across 32 countries (Oct 2011-Dec 2013).
  • Assessed GPs' perceptions of who makes the referral decision to understand SDM.
  • Employed multilevel logistic models and analyzed GP responses on referral decision factors.

Main Results:

  • Significant variation observed in reported SDM among GPs globally (35% to 90%).
  • Gatekeeping systems showed a negative correlation with SDM, though country-specific deviations exist.
  • GPs in gatekeeping systems prioritized patient interests, while non-gatekeeping systems favored GP experience and benchmarking.

Conclusions:

  • GPs in gatekeeping systems appear less inclined towards SDM compared to those in non-gatekeeping systems.
  • The relationship between gatekeeping systems and SDM is complex and not strictly linear.
  • A nuanced, contextual approach is necessary to fully understand the impact of gatekeeping on SDM in primary care referrals.