Factors Associated With Primary Care Physician Decision-making When Making Medication Recommendations vs Surgical Referrals

Abstract

ImportanceAlthough objective data are used routinely in prescription drug recommendations, it is unclear how referring physicians apply evidence when making surgeon or hospital recommendations for surgery.ObjectiveTo compare the factors associated with the hospital or surgeon referral decision-making process with that used for prescription medication recommendations.Design, Setting, and ParticipantsThis qualitative study comprised interviews conducted between April 26 and May 18, 2021, of a purposive sample of 21 primary care physicians from a large primary care network in the Northeast US.Main Outcomes and MeasuresMain outcomes were the factors considered when making prescription medication recommendations vs referral recommendations to specific surgeons or hospitals for surgery.ResultsAll 21 participant primary care physicians (14 women [66.7%]) reported use of evidence-based decision support tools and patient attributes for prescription medication recommendations. In contrast, for surgeon and hospital referral recommendations, primary care physicians relied on professional experience and training, personal beliefs about surgical quality, and perceived convenience. Primary care physicians cited perceived limitations of existing data on surgical quality as a barrier to the use of such data in the process of making surgical referrals.Conclusions and RelevanceAs opposed to the widespread use of objective decision support tools for guidance on medication recommendations, primary care physicians relied on subjective factors when making referrals to specific surgeons and hospitals. The findings of this study highlight the potential to improve surgical outcomes by introducing accessible, reliable data as an imperative step in the surgical referral process.

Effect of patient death on referrals to cardiac specialists

“…Existing evidence suggests that referring physicians care about specialist ‘ability’ when making referral decisions (Kinchen et al., 2004; Naik et al., 2023). However, relatively little is known about how referring physicians learn about specialist ability.…”

“…Possible explanations include limited use of report cards by referring physicians, and that these report cards did not provide any new information to referring physicians who were already knowledgeable about the specialist quality (Epstein, 2010; Schneider & Epstein, 1996). Physicians also report relying on their own beliefs about surgeon quality when making referral decisions (Naik et al., 2023). In this paper, I examine how referring physicians might learn about cardiac surgeons' quality through the experiences of their patients.…”

“…Due to asymmetry of information, however, patients often rely on their referring physicians to make this consequential choice (Chernew et al, 2021). Given that referring physicians act as gatekeepers to specialty care, it is important to understand how referring physicians choose providers for their patients.Existing evidence suggests that referring physicians care about specialist 'ability' when making referral decisions (Kinchen et al, 2004;Naik et al, 2023). However, relatively little is known about how referring physicians learn about specialist ability.…”