For the likelihood to consult an ED and likelihood to consult secondary care we found no significant associations (see table 2).
How does the decision to consult primary care and responses from primary care differ if it at all from the decision to consult secondary care or alternative providers?
Dutch GPs were offered the opportunity to consult secondary mental health care professionals, and cooperation between primary and secondary mental health care was stimulated.
The odds ratio for the homeless is 3,271 representing the homeless persons' increase in likelihood to consult secondary care (95% CI = 1,800 - 5,943).
Nagelkerke R² contact with ED: 0,277, Nagelkerke R² contact with secondary care: 0,087 The model focusing on likelihood to consult secondary care explained 8,7% of the variance and demonstrated after adjusting for age and gender, being homeless increases the likelihood to consult secondary care.
In these models, the OR for a homeless person to be likely to consult a GP is 2.592, to consult secondary care 2,683 and to consult an ED 10,752.
The explained variance increases to 21,5% for the model focussing on likelihood to consult a GP, to 11,9% for the model focussing on likelihood to consult secondary care and to 33,3% for the model focussing on likelihood to consult an ED.
Watchful waiting may be an acceptable line of management in primary care, as the majority of women who consult secondary care with heavy menstrual bleeding have no detectable pathology, and, although research on primary care populations is lacking, the rate of significant pathology in primary care is likely to be even lower.
Previous studies were conducted in patients with mostly chronic shoulder pain consulting in secondary care settings, mostly in the diagnostic work-up for surgery.
The analyses were repeated including secondary care data to derive combined primary and secondary care consultation prevalence, on the assumption that some patients may be diagnosed or only consult in secondary care as is particularly likely in Sweden.
