Department of Medicine, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom.
Department of Acute Medicine, Forth Valley Royal Hospital, Stirling Rd, Larbert FK5 4WR, United Kingdom.
Fam Pract. 2023 Mar 28;40(2):233-240. doi: 10.1093/fampra/cmac097.
Variation in general practice (GP) referral rates to outpatient services is well described however variance in rates of referral to acute medical units is lacking.
To investigate variance in GP referral rate for acute medical assessment and subsequent need for hospital admission.
A retrospective cohort study of acute medical referrals from 88 GPs in Lothian, Scotland between 2017 and 2020 was performed using practice population size, age, deprivation, care home residence, and distance from hospital as explanatory variables. Patient-level analysis of demography, deprivation, comorbidity, and acuity markers was subsequently performed on referred and clinically assessed acute medical patients (n = 42,424) to examine how practice referral behaviour reflects clinical need for inpatient hospital care.
Variance in GP referral rates for acute medical assessment was high (2.53-fold variation 1st vs. 4th quartile) and incompletely explained by increasing age and deprivation (adjusted R2 0.67, P < 0.001) such that significant variance remained after correction for confounders (2.15-fold). Patients from the highest referring quartile were significantly less likely to require hospital admission than those from the third, second, or lowest referring quartiles (adjusted odds ratio 1.28 [1.21-1.36, P < 0.001]; 1.30 [1.23-1.37, P < 0.001]; 1.53 [1.42-1.65, P < 0.001]).
High variation in GP practice referral rate for acute medical assessment is incompletely explained by practice population socioeconomic factors and negatively associates with need for urgent inpatient care. Identifying modifiable factors influencing referral rate may provide opportunities to facilitate community-based care and reduce congestion on acute unscheduled care pathways.
全科医生（GP）向门诊服务转诊的比例差异已有充分描述，但向急性内科转介率的差异则缺乏研究。
调查 GP 对急性内科评估的转诊率及其随后住院需求的差异。
采用回顾性队列研究，分析了苏格兰洛锡安区 2017 年至 2020 年间 88 位全科医生的急性内科转诊情况，使用实践人群规模、年龄、贫困程度、养老院居住情况和与医院的距离作为解释变量。随后对转诊和临床评估的急性内科患者（n=42424）进行患者水平的人口统计学、贫困程度、合并症和疾病严重程度标志物分析，以研究实践转诊行为如何反映临床对住院治疗的需求。
GP 对急性内科评估的转诊率差异很大（第 1 四分位与第 4 四分位差异达 2.53 倍），且不能仅用年龄和贫困程度增加来解释（调整后的 R2 为 0.67，P＜0.001），因此在调整混杂因素后仍存在显著差异（2.15 倍）。来自转诊率最高四分位的患者与来自第三、第二或最低四分位的患者相比，住院需求显著降低（调整后的优势比为 1.28 [1.21-1.36，P＜0.001]；1.30 [1.23-1.37，P＜0.001]；1.53 [1.42-1.65，P＜0.001]）。
GP 对急性内科评估的转诊率差异很大，不能仅用实践人群的社会经济因素来解释，而且与紧急住院需求呈负相关。确定影响转诊率的可调节因素可能为促进社区护理和减少急性非计划性护理途径拥堵提供机会。
