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Variation in Practice: A Questionnaire Survey of How Congruence in Attitudes Between Doctors and Patients Influences Referral Decisions

Stein Rokkan Centre for Social Studies, benedicte.carlsen{at}rokkan.uib.no

Arild Aakvik, DrPolit

Department of Economics, University of Bergen

Ole F. Norheim, DrMed

Department of Public Health and Primary Health Care University of Bergen, Bergen, Norway

Background. There is a well-known and partly unexplained variation in referral rates among general practitioners (GPs). GPs who are positive toward shared decision making refer less to secondary care, but how congruence in attitudes between doctors and patients influences referral rates has not been investigated. In this study, the authors analyze whether congruence in attitudes between the GP and patients toward shared decision making affects the GP's referral rate. Methods. Questionnaire survey was distributed by 56 Norwegian GPs, each to 50 consulting patients. The level of congruence in attitudes toward shared decision making of GPs and corresponding patients was measured by the Patient-Practitioner Orientation Scale. The survey also included self-reported referral rates. Results. In total, 1268 patients (45%) returned the questionnaires. Respondents were eliminated if they did not fully answer the questionnaire, resulting in a working sample of 835 patients. The authors found that congruence of attitudes toward shared decision making between the GP and patients had a negative effect on referral rate. Conclusion. In this study, congruence of attitudes toward shared decision making between GPs and patients influences referral decisions, indicating that matching attitudes may enhance the effort to solve the medical problem within the GPs' practice (i.e., doctor-patient interaction explains some of the variation in practice). The study supports the policy argument that, if possible, health authorities should enhance the possibilities for patients to choose a GP of matching attitudes.

Key Words: patient involvement • physician-patient relationship • referral patterns • variation in practice style. (Med Decis Making 2008;28:262—268)

This version was published on March 1, 2008

Medical Decision Making, Vol. 28, No. 2, 262-268 (2008)
DOI: 10.1177/0272989X07311751


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