GPs' motives for referrals to general hospitals: does access to GP hospital beds make any difference?

We aimed to explore the relative impact of medical and other situational motives on GP's decisions to refer patients to specialist care in a general hospital, and to assess whether having access to a GP hospital influences the decisions.

We carried out a prospective study of consecutive doctor-patient contacts during one week. The effects of main motives, medical, social/nursing, general hospital advice, distance from the nearest general hospital and access to GP hospitals on referral decisions were explored by logistic regression. The motives for different referral decisions were also explored through frequency analyses. The study was set in general practices in the county of Finnmark in North Norway, which included 40 GPs from rural practices with access to a GP hospital and eight GPs working closer to a general hospital without access to GP hospital. We studied 2496 doctor-patient contacts, which resulted in 411 patients being considered for any kind of referral, of which 205 were referred to the general hospital.

Medical needs were recorded as the only referral motive of major importance in about half of the cases considered for referral, while additional motives were recorded in the other half. The rationale for admissions to general hospitals and GP hospitals (in-patient care) was compatible in terms of the relative importance of the medical arguments. The GP hospital option was mainly chosen because of the long distance from the general hospital, nursing needs and the preferences of the patient and the family, and resulted in a lower proportion of patients being referred to general hospitals from GPs with access to a GP hospital.

Medical motives dominate the decision to refer patients to general hospitals, but access to a GP hospital, in cases where nursing needs and long distances to the general hospital are supplementary considerations, reduces the proportion of patients being referred to general hospitals.