Risk taking in general practice: GP out-of-hours referrals to hospital.

Tytuł:: Risk taking in general practice: GP out-of-hours referrals to hospital.
Autorzy:: Ingram JC; RDS-SW(Bristol), Education Centre, University Hospitals Bristol NHS Foundation Trust, Bristol. />Calnan MW
Greenwood RJ
Kemple T
Payne S
Rossdale M
Źródło:: The British journal of general practice : the journal of the Royal College of General Practitioners [Br J Gen Pract] 2009 Jan; Vol. 59 (558), pp. e16-24.
Typ publikacji:: Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Original Publication: London : Royal College of General Practitioners
MeSH Terms:: Professional Practice*
After-Hours Care/*statistics & numerical data
Emergency Service, Hospital/*statistics & numerical data
Family Practice/*statistics & numerical data
Referral and Consultation/*statistics & numerical data
After-Hours Care/trends ; Attitude of Health Personnel ; Cross-Sectional Studies ; Emergency Service, Hospital/trends ; England ; Family Practice/trends ; Female ; Hospitalization/statistics & numerical data ; House Calls/statistics & numerical data ; Humans ; Male ; Referral and Consultation/trends ; Risk-Taking ; Sex Factors ; Surveys and Questionnaires
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BMJ. 2005 Feb 5;330(7486):289-92. (PMID: 15695276)
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BMJ. 2008 Apr 5;336(7647):731-2. (PMID: 18390498)
Entry Date(s):: Date Created: 20081225 Date Completed: 20090123 Latest Revision: 20211020
Update Code:: 20240104
PubMed Central ID:: PMC2605545
DOI:: 10.3399/bjgp09X394824
PMID:: 19105912
: Czasopismo naukowe

Background: Emergency admissions to hospital at night and weekends are distressing for patients and disruptive for hospitals. Many of these admissions result from referrals from GP out-of-hours (OOH) providers.
Aim: To compare rates of referral to hospital for doctors working OOH before and after the new general medical services contract was introduced in Bristol in 2005; to explore the attitudes of GPs to referral to hospital OOH; and to develop an understanding of the factors that influence GPs when they refer patients to hospital.
Design of Study: Cross-sectional comparison of admission rates; postal survey.
Setting: Three OOH providers in south-west England.
Method: Referral rates were compared for 234 GPs working OOH, and questionnaires explored their attitudes to risk.
Results: There was no change in referral rates after the change in contract or in the greater than fourfold variation between those with the lowest and highest referral rates found previously. Female GPs made fewer home visits and had a higher referral rate for patients seen at home. One-hundred and fifty GPs responded to the survey. Logistic regression of three combined survey risk items, sex, and place of visit showed that GPs with low 'tolerance of risk' scores were more likely to be high referrers to hospital (P<0.001).
Conclusion: GPs' threshold of risk is important for explaining variations in referral to hospital.

Comment in: Br J Gen Pract. 2009 Jan;59(558):3-4. (PMID: 19105908)

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