چکیده (انگلیسی):

Background:In a gatekeeper system, primary care physicians and patients jointly decide whether or not medical
specialist care is needed. However, it is the patient who decides to actually use the referral. Referral non-compliance
could delay diagnosis and treatment. The objective of this study was to assess patient compliance with a referral to
medical specialist care and identify patient and practice characteristics that are associated with it.
Methods:Observational study using data on 48,784 referrals to medical specialist care derived from electronic medical
records of 58 general practices for the period 2008–2010. Referral compliance was based on claims data of
medical specialist care. Logistic multilevel regression analyses were conducted to determine associations between
patient and general practice characteristics and referral compliance.
Results:In 86.6 % of the referrals, patients complied. Patient and not practice characteristics were significantly
associated with compliance. Patients from deprived urban areas and patients aged 18–44 years were less likely to
comply, whereas patients aged 65 years and older were more likely to comply.
Conclusion:About 1 in 8 patients do not use their referral. These patients may not receive adequate care.
Demographic and socio-economic factors appear to affect compliance. The results of this study may be used
to make general practitioners more aware that some patients are more likely to be noncompliant with
referrals.