General practitioner referrals to paediatric specialist outpatient clinics: referral goals and parental influence

Abstract

INTRODUCTION Previous research on general practitioner (GP) referrals in adult populations demonstrated that patient pressure influenced referral practice. No research has been conducted to investigate how involvement of a parent influences paediatric referrals. AIM To investigate whether GPs who report parental influence on their decision to refer paediatric patients differ in their referral patterns from GPs who do not report parental influence. METHOD A mail survey of 400 GPs who had referred at least two children to paediatric specialist outpatient clinics during 2014 was distributed. RESULTS The response rate was 67% (n = 254). For initial referrals, 27% of GPs stated that parental request frequently or almost always influenced their referral decision. For returning referrals, 63% of GPs experienced parental influence to renew a referral because a paediatrician wanted a child to return; 49% of GPs experienced influence to renew a referral because a parent wanted to continue care with a paediatrician. Experiencing parental influence was associated with increased likelihood for frequent referrals in order for a paediatrician to take over management of a child's condition. DISCUSSION GPs who frequently refer with a goal for a paediatrician to take over management of a child's condition also report that parental request almost always influences their decision to refer.

Factors influencing general practitioners decisions to refer Paediatric patients to the emergency department: a systematic review and narrative synthesis

“…While some factors are applicable to both adult and children populations, certain factors may be more pertinent in the case of children. Parental influence featured prominently, reflecting previous research on parental or patient pressure to refer [2,12,15,18,19,32]. When seeking unscheduled healthcare, parental anxiety may be considerably heightened leading them to seek reassurance [18,25,29].…”

“…This review offers some insight regarding GPs reaction to parental request; while in one study GPs reported trust in parents' instincts regarding their children's health status, in another it generated a "moral conflict" for GPs [25,26]. Consideration of a parent's request for a referral shows respect for parent's wishes regarding their children's care [2]. Participation in medical decision-making improves quality of care and health outcomes [37], and has been shown to improve parents' satisfaction and linked to reducing unnecessary antibiotic use for children [38].…”

“…Erring on the side of caution may be pronounced when dealing with small children whose condition can deteriorate quickly. Research has shown GPs may have less confidence with paediatric patients due to a lack of paediatric training or experience in treating children [2,7,14].…”

“…General practitioners (GPs) are often the first point of contact to healthcare, acting as a gateway to emergency, specialist, or other secondary care services in many countries [1,2]. Rising utilization of emergency departments (ED) has been recorded internationally, leading to increased attention to reducing demand on emergency services [3,4].…”

From the Editor: Stretching

“…10 We have further research papers investigating vaccination decisions during pregnancy, 11 analysing the routinely collected New Zealand Health Survey data to study health service utilisation, 12 showing children's slowly developing recovery from traumatic brain injury, 13 and from australia we have research about why general practitioners make referrals to paediatric specialists. 14 Our New Zealand reviewers regarded this issue as generic, internationally. reviewers play a critical part in advancing science so we editors like to occasionally acknowledge them by name, without compromising their anonymity to the authors whose papers they review.…”