Patient Referral to a University Clinic: Patterns in a Rural State

Abstract

Physicians'' reasons for referral to a university clinic which serves primarily a consultative function have been described and some of the factors which affect this referral process determined. A stratified, random sample of physicians in the referral area and of patients they had recently referred was selected and interviewed. Evidence from interviews with 84 referring physicians and the patients they referred indicate that approximately 50% of referrals nominally initiated by physicians to this Clinic are probably referrals made primarily on the patients'' initiation. In only about one-fourth of referrals was a rather specific, physician-initiated reason for referral given. Distance from the referral center, or some factor related to it, appeared to be an important determinant of reasons for referral: referrals from greater distances were largely for specific, physician-initiated reasons, whereas referrals from nearby were largely patient-initiated. Physicians, though aware of the patients'' influence upon their patterns of referral, seemed to underestimate its magnitude. The general views of general practitioners about their patterns of referral coincided more closely with what was actually found with a sample of specific patients than was true for specialists. The mean age of physicians giving specific reasons for referral was lower than that of physicians giving non-specific reasons. Other related observations are that for 58% of referrals in this sample no medical information was sent by the referring physician, and that 54% of the patients had not returned to a continuing relationship with the referring physician after the clinic workup was completed.