Variation in general practice referral rate to acute medicine services and association with hospital admission. A retrospective observational study

Author:

Lyall Marcus J1ORCID,Beckett Dan2,Price Anna3,Strachan Mark W J4ORCID,Jamieson Clare5,Morton Catriona6,Begg Drummond7,Simpson Johanne1,Lone Nazir8ORCID,Cameron Allan9

Affiliation:

1. Department of Medicine, Royal Infirmary of Edinburgh , 51 Little France Cres, Edinburgh EH16 4SA , United Kingdom

2. Department of Acute Medicine, Forth Valley Royal Hospital , Stirling Rd, Larbert FK5 4WR , United Kingdom

3. Department of Public Health, Medical Statistician, Western General Hospital , Crewe Rd S, Edinburgh EH4 2XU , United Kingdom

4. Metabolic Unit, Western General Hospital , Crewe Rd S, Edinburgh EH4 2XU , United Kingdom

5. Gullane Medical Practice , Hamilton Road, Gullane, East Lothian EH31 2HP , United Kingdom

6. Craigmillar Medical Group , 106 Niddrie Mains Road, Edinburgh EH16 4DT , United Kingdom

7. Penicuik Medical Practice , 37 Imrie Place, Penicuik EH26 8LF , United Kingdom

8. Usher Institute, University of Edinburgh , Edinburgh EH8 9AG , United Kingdom

9. Department of Acute Medicine, Acute Assessment Unit, Jubilee Building, Glasgow Royal Infirmary , Glasgow G4 0SF , United Kingdom

Abstract

Abstract Background 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. Objective To investigate variance in GP referral rate for acute medical assessment and subsequent need for hospital admission. Methods 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. Results 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]). Conclusions 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.

Publisher

Oxford University Press (OUP)

Subject

Family Practice

Reference36 articles.

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