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Primary care residents' practice style predicts their referral of patients to specialty care

Nearly 5 percent of patient visits to a primary care provider result in a referral to a specialist. Physician practice style as well as patient factors such as age and health status influence these referrals. In fact, a new study by University of California, Davis researchers found that primary care residents with a technically oriented style of care were more likely than other residents to refer patients to specialty clinics.

With support from the Agency for Healthcare Research and Quality (HS06167), Klea D. Bertakis, M.D., M.P.H., and her colleagues analyzed the influence of patient factors (sociodemographic characteristics, such as age, sex, race, and income; self-reported health status; and number of primary care visits) and primary care resident practice style on patient referrals to specialists. They randomly assigned 509 new adult patients to residents at a university medical center and monitored patient referrals for 1 year of care.

Patients who were referred to specialty care were significantly older, had poorer physical health, and saw their primary care doctors more often than patients who were not referred. About 13 percent of the variance in medical specialty referrals was explained by these factors. However, after controlling for these patient factors, visits to a resident physician who had a technically oriented style of care was associated with a greater total number of referrals to specialty clinics. Together, these factors accounted for 18 percent of the variation in total specialty referrals.

An exception was referral to a mental health specialty clinic, which was predicted only by the number of primary care visits and the physician's psychosocial style of care (a doctor who discusses with the patient his or her interpersonal relations or current emotional state). The influence of residents' practice style on referral patterns is important because professional practice style is shaped during residency training and may be expected to influence future referral patterns.

More details are in "Predictors of patient referrals by primary care residents to specialty care clinics," by Dr. Bertakis, Edward J. Callahan, Ph.D., Rahman Azari, Ph.D., and John A. Robbins, M.D., M.H.S., in the March 2001 Family Medicine 33(3), pp. 203-209.

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