Influence of referral source on return compliance of adolescents

To determine the effect of the source of referral on appointment compliance of adolescents to referring doctors or to consultants at tertiary medical centers.

This analysis included 421 adolescent patients aged 10-18 years who were referred to the tertiary teaching hospital in Taiwan by 75 primary care doctors, including 56 pediatricians and 19 general practitioners in 1987-1996. Medical records were abstracted to determine clinical severity and demography. Data of compliance with return appointments were collected by an independently trained interviewer.

A total of 18.07% of referrals were initiated by patients or families and 81.93% were initiated by primary care doctors. More severe illness was found in patient-initiated referrals than in doctor-initiated referrals. After controlling for demographic, family features, medical payment, and doctor specialty, this study showed that if the referral were initiated by patients or families, adolescent patients were less likely to return to either the primary care doctors or tertiary teaching hospitals.

Although in a competitive environment, follow-up care is more likely to occur for both primary care doctors and consultants at tertiary teaching hospitals when the referral was initiated by primary care doctors.