SIIReN - System Integration & Innovation Research Network

Primary Health Care System

Click here to open .pdf document

“Patterns of Specialty Medical Referral: Analysis of a Primary Health Care Electronic Medical Record Database"
Presenters: Dr. Joshua Shadd, Dr. Bridget L. Ryan, Dr. Moira Stewart, Dr. Armadeep Thind
May 19, 2011


Context: Most patient visits to specialist physicians are initiated by referral from a Family Physician (FP).  Little is known about the overall referral patterns and wait times from Canadian FPs to medical specialists.

Objective:  Describe the rate of referrals and wait times from FPs to specialist physicians according to patient demographics, practice location and specialist physician type.

Design:  The Deliver Primary Healthcare Information (DELPHI) database contains the de-identified records of over 30,000 patients. 

Setting: 10 family practices in Southwestern Ontario.

Patients: Of the 24,856 patients with at least one FP visit between April 1, 2007 and March 31, 2008, 7771 had at least one medical referral. Wait times were established for 16,115 referrals that occurred from October, 2005 to March 2008.
Outcome Measures: Rates of referrals to medical specialties per 1000 patients, compared by patient sex, age, number of FP visits, and urban/rural practice location.  Wait times, described by sex, age, and specialty.

Results: The overall rate of referral was 455 per 1000 patients per year.  Rates of referral were higher for women than men (471 vs. 436, p=0.001), and for patients from rural compared to non-rural practices (476 vs. 424, p=0.0001).  Referral rates increased significantly with age (p=0.0001) and correlated strongly with the number of FP visits.  The highest rates of referral were to General Surgery, Obstetrics/Gynecology, Orthopedic Surgery, and Dermatology. Mean wait time was 74 days with a median wait time of 47 days. Wait times varied significantly by specialty.

Conclusions: Rates of referral to medical specialists vary by patient factors (sex, age), physician factors (location) and specialist type.  Wait times from the family physician to a specialist vary by specialty and contribute to the overall wait times patients experience. EMR data provide an opportunity to explore further variations in patterns of referrals.

Back to Research Rounds page