[Attitudes and empirical referral data of West German family physicians]

The large inter-doctor variation in referrals to specialists known from previous research can only partly be explained by differences in presented morbidity, in practice setting or in general practitioners' (GPs') attitudes to their own work. The objective of this study was to analyse GPs' attitudes towards their own work and their influence on referral behaviour. This work is a follow up of the European study of referrals from primary to specialist care carried out in nine countries. We present an analysis of the West German part involving the same sample as in the European referral study. To 75 GPs a questionnaire with 26 items was sent, which validity and reliability was measured in studies before. 71 GPs took part in the study (response rate 95%). GPs with a high referral rate perform some technical procedures less frequently than GPs with a low referral rate. Many GPs consider their clinical responsibilities to be greater than their actual performance would suggest. In general, GPs tended to minimize risks. Significant correlations between attitudes and referral rates were found for 7 items only. GPs attitudinal consensus had no firm association to their referral behaviour (as measured by the instruments used). To explain this finding structural and financial aspects of the health care system should be taken into account. Further investigations about the referral process including a qualitative approach are necessary.