Gatekeeping and referrals to cardiologists: General practitioners’ views on interactive communications

Figures & data

Table I. GPs’ opinions about the pre-referral process, and goals of a referral system to cardiologists: Those living in the urban area* are compared with those in the rural areas of Iceland (percentages; absolute numbers in parentheses).

	Total	Urban area*	Rural area	p-value
When I refer a patient, the situation is “rather often” or “very often” that the initiative comes from the patient, or the referral is not at my initiative	88 (110/125)	98 (61/62)	68 (27/40)	< 0.001
When I refer a patient, I “often” or “very often” feel that I could have handled the matter myself instead of making the referral	78 (93/120)	88 (51/58)	55 (22/40)	< 0.001
When I write a referral, it is “rather” or “very” seldom that the aim is to get specialist “help with diagnosis or treatment”, “to exclude serious disease”, or “to get better information about treatment options”	76 (91/120)	85 (51/60)	66 (25/38)	< 0.05
When the issue of referral arises, I “often” or “very often” lack information about the patient for the purpose of writing a referral of high quality.	30 (36/122)	41 (25/61)	18 (7/39)	< 0.05

Notes: *Reykjavik, Kopavogur, Hafnarfjördur, Gardabaer, Seltjarnarnes, Mosfellsbaer and Reykjanesbaer.

Table II. Possible professional gain from a referral system according to the GPs’ opinions: Those living in the urban area* are compared with those in the rural areas of Iceland (percentages; absolute numbers in parentheses).

	Total	Urban area*	Rural area	p-value
The new referral system is for the benefit of the patients as it adds to the GP's medical information	63 (77/122)	80 (48/61)	39 (15/38)	0.001
Information in the response letters from the cardiologists is helpful	98 (122/125)	97 (60/62)	98 (39/40)	NS
I am satisfied, “very much”, “rather much”, or “moderately” with the present referral system.	50 (61/123)	44 (27/62)	62 (24/39)	NS
GPs who estimate that they get a letter in more than 50% of cases from the cardiologists	64 (79/123)	54 (33/61)	82 (32/39)	0.01
I am more alert than before to the number of patients in my practice with cardiovascular diseases.	25 (31/124)	34 (21/62)	12 (5/41)	< 0.05

Notes: *Reykjavik, Kopavogur, Hafnarfjördur, Gardabaer, Seltjarnarnes, Mosfellsbaer and Reykjanesbaer. NS = not significant.