Show simple item record

dc.contributor.authorMontgomery, Anthony J
dc.contributor.authorMcGee, Hannah M
dc.contributor.authorShannon, William
dc.contributor.authorDonohoe, John
dc.date.accessioned2010-04-06T10:16:22Z
dc.date.available2010-04-06T10:16:22Z
dc.date.issued2006
dc.identifier.citationFactors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study. 2006, 6:114 BMC Health Serv Resen
dc.identifier.issn1472-6963
dc.identifier.pmid16970805
dc.identifier.doi10.1186/1472-6963-6-114
dc.identifier.urihttp://hdl.handle.net/10147/95627
dc.description.abstractBACKGROUND: 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.
dc.language.isoenen
dc.subject.meshAge Factors
dc.subject.meshCreatinine
dc.subject.meshDecision Making
dc.subject.meshFactor Analysis, Statistical
dc.subject.meshFamily Practice
dc.subject.meshFemale
dc.subject.meshHumans
dc.subject.meshInterviews as Topic
dc.subject.meshIreland
dc.subject.meshKidney Failure, Chronic
dc.subject.meshMale
dc.subject.meshMarital Status
dc.subject.meshMedicine
dc.subject.meshMiddle Aged
dc.subject.meshNephrology
dc.subject.meshPhysician's Practice Patterns
dc.subject.meshQuestionnaires
dc.subject.meshReferral and Consultation
dc.subject.meshRenal Dialysis
dc.subject.meshSpecialization
dc.subject.meshUrology
dc.titleFactors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study.en
dc.contributor.departmentDepartment of Psychology, Royal College of Surgeons in Ireland-Medical University of Bahrain, PO Box 15503, Manama, Bahrain. amontgomery@rcsi-mub.comen
dc.identifier.journalBMC health services researchen
refterms.dateFOA2018-09-03T10:42:58Z
html.description.abstractBACKGROUND: 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.


Files in this item

Thumbnail
Name:
16970805.pdf
Size:
845.0Kb
Format:
PDF

This item appears in the following Collection(s)

Show simple item record