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The issue of referral was introduced more frequently in consultations with high referrers, and also resulted more often in referrals.
The issue of referral was introduced in 23% of the consultations, and in 70.6% of these cases by the GP.
This implies tackling the issue of referral fees and the production of national guidelines for diagnosis and treatment.
The GPs recorded whether the issue of referral was introduced, who introduced it and if the patient was referred.
In our study, the relative proportion of referrals was about the same whether the patient or the GP initiated the issue of referral.
The frequency of introducing the issue of referral in the consultation and the corresponding referral rates are different in high and low referrers.
In order to improve health care in general – and passive case finding for tuberculosis in particular – the issue of referral needs explicit attention.
The issue of referral was introduced in 23% of the consultations, introduced by the GPs in 70.6% of these, and by the patients in 29.4%, but the following referral rate was very much the same.
In sub-analyses in our study we found that female GPs referred a significantly larger proportion of patients than males when the issue of referral was introduced, especially when the GPs initiated the issue.
For this first group of GPs the issue of referral for abortion nevertheless sometimes came up in the consultation, mainly because not all patients disclose their agenda to the secretaries.
We had anticipated that the referral rate would be higher when GPs initiated the issue of referral, and we therefore think our result indicates a stronger responsiveness to the patient's requests on the part of the GP, resulting in difficulties or reluctance to make rationing decisions.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com