Langley G R, MacLellan A M, Sutherland H J, Till J E
Department of Medicine, Dalhousie University, Halifax, NS.
CMAJ. 1992 Sep 1;147(5):659-66.
To identify nonmedical factors perceived by family physicians (FPs) and consultants as important influences on decisions about referral for consultation, to determine the relative frequency with which such factors are cited and to identify those factors ranked as most important by the FPs and consultants.
Survey with semistructured interview between July 1989 and April 1990.
A total of 41 FPs and 20 consultants who were practising or had practised previously in Nova Scotia.
The questionnaire comprised 10 questions: 4 were nondirective "probes" designed to elicit responses without suggesting possible answers, 2 asked the participants to rank such responses in order of importance, and 4 were "prompts" that asked for comments about a list of factors based on a review of the literature.
A total of 4845 discrete items were mentioned as being capable of influencing FPs' decisions about referral for consultation. Aggregation of related items resulted in a list of 35 nonmedical factors, of which 11 were identified by at least half the respondents and 14 by less than half but more than 10. These 25 factors fell into three categories: patient and family factors (e.g., patient's wishes), FP and consultant factors (e.g., FP's capabilities), and other influences (e.g., style of practice). On the basis of both frequency of identification and priority scores "patient's wishes" emerged as the most important factor. Two medical factors that were consistently cited--type of problem and age of patient--were thought to interact with the other factors.
Certain nonmedical considerations may substantially affect physicians' referral practices.
确定家庭医生（FP）和会诊医生认为对转诊会诊决策有重要影响的非医学因素，确定提及这些因素的相对频率，并找出被FP和会诊医生列为最重要的因素。
1989年7月至1990年4月期间进行的半结构化访谈调查。
共有41名正在新斯科舍省执业或曾在此执业的FP和20名会诊医生。
问卷包含10个问题：4个是非指导性“探究性问题”，旨在引出回答而不暗示可能的答案；2个要求参与者按重要性对这些回答进行排序；4个是“提示性问题”，要求根据文献综述对一系列因素发表评论。
总共提及了4845个离散项目，认为它们能够影响FP的转诊会诊决策。对相关项目进行汇总后得到一份包含35个非医学因素的清单，其中11个被至少一半的受访者提及，14个被不到一半但超过10%的受访者提及。这25个因素分为三类：患者及家庭因素（如患者意愿）、FP与会诊医生因素（如FP的能力）以及其他影响因素（如执业风格）。基于识别频率和优先级评分，“患者意愿”成为最重要的因素。两个经常被提及的医学因素——问题类型和患者年龄——被认为与其他因素相互作用。
某些非医学因素可能会对医生的转诊行为产生重大影响。
