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    Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study.

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    Authors
    Montgomery, Anthony J
    McGee, Hannah M
    Shannon, William
    Donohoe, John
    Affiliation
    Department of Psychology, Royal College of Surgeons in Ireland-Medical University of Bahrain, PO Box 15503, Manama, Bahrain. amontgomery@rcsi-mub.com
    Issue Date
    2006
    MeSH
    Age Factors
    Creatinine
    Decision Making
    Factor Analysis, Statistical
    Family Practice
    Female
    Humans
    Interviews as Topic
    Ireland
    Kidney Failure, Chronic
    Male
    Marital Status
    Medicine
    Middle Aged
    Nephrology
    Physician's Practice Patterns
    Questionnaires
    Referral and Consultation
    Renal Dialysis
    Specialization
    Urology
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    Citation
    Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study. 2006, 6:114 BMC Health Serv Res
    Journal
    BMC health services research
    URI
    http://hdl.handle.net/10147/95627
    DOI
    10.1186/1472-6963-6-114
    PubMed ID
    16970805
    Abstract
    BACKGROUND: To understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted. METHOD: Randomly selected general practitioners (N = 51) were interviewed using 32 standardised written patient scenarios to elicit referral strategies. Main outcome measures: General practitioner referral levels and thresholds for patients developing end-stage renal disease; referral routes (nephrologist vs other physicians); influence of patient age, marital status and co-morbidity on referral. RESULTS: Referral levels varied widely with the full range of cases (0-32; median = 15) referred by different doctors after consideration of first laboratory results. Less than half (44%) of cases were referred to a nephrologist. Patient age (40 vs 70 years), marital status, co-morbidity (none vs rheumatoid arthritis) and general practitioner prior specialist renal training (yes or no) did not influence referral rates. Many patients were not referred to a specialist at creatinine levels of 129 micromol/l (47% not referred) or 250 micromol/l (45%). While all patients were referred at higher levels (350 and 480 micromol/l), referral to a nephrologist decreased in likelihood as scenarios became more complex; 28% at 129 micromol/l creatinine; 28% at 250 micromol/l; 18% at 350 micromol/l and 14% at 480 micromol/l. Referral levels and routes were not influenced by general practitioner age, sex or practice location. Most general practitioners had little current contact with chronic renal patients (mean number in practice = 0.7, s.d. = 1.3). CONCLUSION: The very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition.
    Language
    en
    ISSN
    1472-6963
    ae974a485f413a2113503eed53cd6c53
    10.1186/1472-6963-6-114
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