Patient Age,Visit Purpose,and the Ordering of Consultations in a Primary Care Clinic

Abstract

In this study we examine what factors determine whether patients seen in a Veterans Administration primary care clinic will be referred to specialty clinics. It is based on a 25% sample of all patients seen by the medical residents in one clinic over an 18-month period. Our dependent variable is whether the patient was referred for a consultation or not. We performed separate regression analyses for patients who visited the clinic with acute complaints, with chronic-flareup complaints, and with chronic-routine complaints. Within each of these three categories, we further subdivided our sample into patients under and over 65. In each of the six regression equations we controlled for the medical diagnosis and for each resident's work load, residency year, and training. Work load and residency year had opposite (and unpredicted) effects for patients over the age of 65 compared to those under the age of 65. Higher work loads were associated with higher consultation rates for patients over 65 and with lower rates for those under 65. Residency year had a negative effect on referrals for patients over 65 and a positive effect for patients under 65.

Get full access to this article

View all access options for this article.

References

Eisenberg, J. M. (1979). Sociologic influences on decision-making by clinicians. Annals of Internal Medicine, 90, 957-964.

Everett, G. D. , Parsons, T. J. , & Christensen, A. L. (1984). Educational influences on consultation rates of house staff physicians in a primary care clinic. Journal of Medical Education, 59, 479-485.

Freidson, E. (1975). Doctoring together: A study of professional social control. New York: Elsevier.

Kendall, P. L. (1963). The learning environments of hospitals. In E. Freidson (Ed.), The hospital in modern society (pp. 195-230). Glencoe, IL: Free Press.

Mechanic, D. (1979). Correlates of physician utilization: Why do major multivariate studies of physician utilization find trivial psychosocial and organizational effects? Journal of Health and Social Behavior, 20, 387-396.

Metcalfe, D. H. , & Sischy, D. (1974). Patterns of referral from family practice. Journal of Family Practice, 1, 34-38.

Mizrahi, T. (1986). Getting rid of patients: Contradictions in the socialization of physicians. New Brunswick, NJ: Rutgers University Press.

Mumford, E. (1970). Interns: From students to physicians. Cambridge, MA: Harvard University Press.

National Center for Health Statistics . (1977). The national ambulatory medical care survey: Vital and health statistics (Series 13, No. 44, DHEW Pub. No. 80-1795). Washington, DC: U.S. Government Printing Office.

10.

Penchansky, R. , & Fox, D. (1970). Frequency of referral and patient characteristics in group practice. Medical Care, 8, 368-385.

11.

Pineault, R. (1977). The effect of medical training factors on physician utilization behavior. Medical Care, 15, 51-67.

12.

Rhee, S-O. (1977). Relative importance of physicians' personal and situational characteristics for the quality of patient care. Journal of Health and Social Behavior, 18, 10-15.

13.

Rosenblatt, R. A. , & Moscovice, I. S. (1984). The physician as gatekeeper: Determinants of physicians' hospitalization rates. Medical Care, 22, 150-159.

14.

Schlesselman, J. J. (1982). Case-control studies: Design, conduct, analysis. New York: Oxford University Press.

15.

Shortell, S. M. , & Vahovich, S. G. (1975). Patient referral differences among specialties. Health Services Research, 10, 146-161.

16.

Starr, P. (1982). The social transformation of American medicine. New York: Basic Books.