Differences in referral patterns for rural primary care physicians from 2005 to 2016

Abstract

| INTRODUC TI ONReferrals from primary care physicians (PCP) to specialists and among different specialists and subspecialists are important contributors to medical care costs and quality. 1,2 Referrals have increased over time, potentially due to the increased complexity of medical care 1 ;research shows PCP referral rates are stable within physician over time, but have significant variation across physicians. 4-6 Referrals contribute to appropriate medical care 1,4 ; better understanding current determinants of referrals and appropriate use is important for improving care delivery, particularly in medically underserved rural areas. 7,8 Access to care and availability of specialists are concerns in rural areas due to distance to providers and the nonrural location of many specialists. 7-10 This results in decreased specialist visits and an increased reliance on PCPs in rural areas. 11The ideal PCP referral rate within and across conditions to optimize patient care to provide the highest quality at the lowest cost is unknown. Referrals may be both over-and under-used by PCPs 12 ; referrals may generate excess spending and increase care fragmentation, but specialists have been shown to be more likely to Abstract Objective: To examine differences in referral patterns in a nationally representative sample between primary care physicians (PCP) practicing in rural vs nonrural areas and changes over time. Study Design: Using the 2005-2016 National Ambulatory Medical Care Survey and multivariate logit regression models, I compare referral patterns of PCPs in rural vs nonrural areas. Data Collection: Multiple years of data were combined.Principal Findings: A PCP visit was 1.9 percentage points (95% confidence interval: 0.1 pp, 3.8 pp) more likely to result in a referral in nonrural areas than rural areas, controlling for physician and patient characteristics, a 17 percent increase. This difference is driven by a widening gap in referral rates between nonrural and rural areas over time, with large differences in later periods. The regression-adjusted predicted probability of a PCP visit resulting in a referral was 71 percent higher in nonrural than rural areas in 2013-2014 and 92 percent higher in 2015-2016. Conclusions:Recognizing that the optimal PCP referral rate is unknown, referrals are less common in rural areas with a widening gap in recent years. This difference may reflect specialist availability, distance to care, or patient preferences. As changes occur to health care financing and delivery, continuing to monitor practice patterns is important to ensure patients are receiving appropriate levels of care across geographic regions. K E Y W O R D S ambulatory care, physician practice patterns, referrals, rural S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Geissler KH. Differences in referral patterns for rural primary care physicians from 2005 to 2016.Health Serv Res. 2020;55:94-102. https ://doi.

Association of Insurance Status With Provision of Recommended Services During Comprehensive Postpartum Visits

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The effect of attitudes, subjective norms and stigma on health‐care providers' intention to recommend medicinal cannabis to patients

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Physician Referrals During Prenatal Care

“…In healthcare generally, referrals have been increasing over time (Barnett et al, 2012;Geissler, 2020). Although the optimal referral rate for most clinical situations is not known, the frequency and nature of referrals varies based on clinical condition (Geissler & Zeber, 2020); geographic location (Geissler, 2020); and insurance, physician, and organizational characteristics (Agha et al, 2019;Barnett et al, 2012;Geissler et al, 2021Mehrotra et al, 2011). Care for individuals during pregnancy may be distinctive in ways that matter for referrals; for example, some specialists may be hesitant to treat pregnant people (Jones et al, 2014;Noonan et al, 2018;Wright et al, 2016).…”