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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Family Practice 1/2014

Comparative performance information plays no role in the referral behaviour of GPs

Zeitschrift:
BMC Family Practice > Ausgabe 1/2014
Autoren:
Nicole ABM Ketelaar, Marjan J Faber, Glyn Elwyn, Gert P Westert, Jozé C Braspenning
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2296-15-146) contains supplementary material, which is available to authorized users.

Competing interests

CZ, a Dutch healthcare insurance company, supported this work. The authors declare that they have no competing interests.

Authors’ contributions

NK conceived the study, drafted the manuscript, and contributed to all other aspects of the study. MF analysed and interpreted the qualitative data. JB helped to design the survey. MF and JB contributed to acquiring the data, and drafting and critically revising this manuscript. GE and GW commented on the draft versions of the manuscript. All authors have read and approved the final manuscript.

Abstract

Background

Comparative performance information (CPI) about the quality of hospital care is information used to identify high-quality hospitals and providers. As the gatekeeper to secondary care, the general practitioner (GP) can use CPI to reflect on the pros and cons of the available options with the patient and choose a provider best fitted to the patient’s needs. We investigated how GPs view their role in using CPI to choose providers and support patients.

Method

We used a mixed-method, sequential, exploratory design to conduct explorative interviews with 15 GPs about their referral routines, methods of referral consideration, patient involvement, and the role of CPI. Then we quantified the qualitative results by sending a survey questionnaire to 81 GPs affiliated with a representative national research network.

Results

Seventy GPs (86% response rate) filled out the questionnaire. Most GPs did not know where to find CPI (87%) and had never searched for it (94%). The GPs reported that they were not motivated to use CPI due to doubts about its role as support information, uncertainty about the effect of using CPI, lack of faith in better outcomes, and uncertainty about CPI content and validity. Nonetheless, most GPs believed that patients would like to be informed about quality-of-care differences (62%), and about half the GPs discussed quality-of-care differences with their patients (46%), though these discussions were not based on CPI.

Conclusion

Decisions about referrals to hospital care are not based on CPI exchanges during GP consultations. As a gatekeeper, the GP is in a good position to guide patients through the enormous amount of quality information that is available. Nevertheless, it is unclear how and whether the GP’s role in using information about quality of care in the referral process can grow, as patients hardly ever initiate a discussion based on CPI, though they seem to be increasingly more critical about differences in quality of care. Future research should address the conditions needed to support GPs’ ability and willingness to use CPI to guide their patients in the referral process.
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