Risk taking in general practice: GP out-of-hours referrals to hospital |
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Authors: | Jenny C Ingram Michael W Calnan Rosemary J Greenwood Terry Kemple Sarah Payne Michael Rossdale |
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Institution: | RDS-SW(Bristol), Education Centre, University Hospitals Bristol NHS Foundation Trust, Bristol;School of Social Policy, Sociology and Social Research, University of Kent, Canterbury;RDS-SW(Bristol), Education Centre, University Hospitals Bristol NHS Foundation Trust, Bristol;Horfield Health Centre, Bristol;School for Policy Studies, University of Bristol, Bristol;Pembroke Road Surgery, Bristol |
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Abstract: | BackgroundEmergency admissions to hospital at night and weekends are distressing for patients and disruptive for hospitals. Many of these admissions result from referrals from GP out-of-hours (OOH) providers.AimTo compare rates of referral to hospital for doctors working OOH before and after the new general medical services contract was introduced in Bristol in 2005; to explore the attitudes of GPs to referral to hospital OOH; and to develop an understanding of the factors that influence GPs when they refer patients to hospital.Design of studyCross-sectional comparison of admission rates; postal survey.SettingThree OOH providers in south-west England.MethodReferral rates were compared for 234 GPs working OOH, and questionnaires explored their attitudes to risk.ResultsThere was no change in referral rates after the change in contract or in the greater than fourfold variation between those with the lowest and highest referral rates found previously. Female GPs made fewer home visits and had a higher referral rate for patients seen at home. One-hundred and fifty GPs responded to the survey. Logistic regression of three combined survey risk items, sex, and place of visit showed that GPs with low ‘tolerance of risk’ scores were more likely to be high referrers to hospital (P<0.001).ConclusionGPs'' threshold of risk is important for explaining variations in referral to hospital. |
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Keywords: | emergency service hospital out-of-hours medical care risk |
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