• Marcus J Lyall, Dan Beckett, Anna Price, StrachanMark W JMWJ0000-0003-2628-1202Metabolic Unit, Western General Hospital, Crewe Rd S, Edinburgh EH4 2XU, United Kingdom., Clare Jamieson, Catriona Morton, Drummond Begg, Johanne Simpson, Nazir Lone, and Allan Cameron.
• Department of Medicine, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom.
• Fam Pract. 2023 Mar 28; 40 (2): 233240233-240.

BackgroundVariation in general practice (GP) referral rates to outpatient services is well described however variance in rates of referral to acute medical units is lacking.ObjectiveTo investigate variance in GP referral rate for acute medical assessment and subsequent need for hospital admission.MethodsA retrospective cohort study of acute medical referrals from 88 GPs in Lothian, Scotland between 2017 and 2020 was performed using practice population size, age, deprivation, care home residence, and distance from hospital as explanatory variables. Patient-level analysis of demography, deprivation, comorbidity, and acuity markers was subsequently performed on referred and clinically assessed acute medical patients (n = 42,424) to examine how practice referral behaviour reflects clinical need for inpatient hospital care.ResultsVariance in GP referral rates for acute medical assessment was high (2.53-fold variation 1st vs. 4th quartile) and incompletely explained by increasing age and deprivation (adjusted R2 0.67, P < 0.001) such that significant variance remained after correction for confounders (2.15-fold). Patients from the highest referring quartile were significantly less likely to require hospital admission than those from the third, second, or lowest referring quartiles (adjusted odds ratio 1.28 [1.21-1.36, P < 0.001]; 1.30 [1.23-1.37, P < 0.001]; 1.53 [1.42-1.65, P < 0.001]).ConclusionsHigh variation in GP practice referral rate for acute medical assessment is incompletely explained by practice population socioeconomic factors and negatively associates with need for urgent inpatient care. Identifying modifiable factors influencing referral rate may provide opportunities to facilitate community-based care and reduce congestion on acute unscheduled care pathways.© The Author(s) 2022. Published by Oxford University Press.

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