Search tips
Search criteria 


Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 1992 March; 42(356): 111–115.
PMCID: PMC1371995

Outpatient clinic referrals and their outcome.


A cohort of 392 patients referred to six outpatient clinics by general practitioners during 1987 with diagnoses of rheumatoid arthritis, osteoarthritis, peripheral vascular disease, psoriasis or eczema, were studied from the time of their first attendance until up to two years later. Six consultant clinics were studied in the three specialties: rheumatology, vascular surgery and dermatology. For each specialty a clinic in both a teaching hospital and a district general hospital were included. The cohort members were predominantly middle-aged or elderly people, with a greater proportion of women, except at the vascular surgery clinic where 65% of patients were men. The 392 patients made a total of 936 visits (median two, range one-eight) during the study period; 91 patients were still attending up to two years after the first visit. Patients referred by their general practitioner for therapy were less likely to be discharged than those referred for other reasons. The principal reason for continuing attendance as perceived by patients, general practitioners and hospital doctors was the necessity for consultant supervision, although agreement was far from complete in individual cases. Junior staff tended to see a higher proportion of patients at follow-up visits than did consultants, and were found to have lower discharge rates than consultants. Analyses of data showed that at the first visit, diagnosis, disease severity and the grade of doctor seeing the patient in the clinic was significantly associated with patient discharge at the P < 0.05 level of significance. Patients considered that their visits had produced improvement in their condition in 38% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Cummins RO, Jarman B, White PM. Do general practitioners have different "referral thresholds"? Br Med J (Clin Res Ed) 1981 Mar 28;282(6269):1037–1039. [PMC free article] [PubMed]
  • Wilkin D, Smith AG. Variation in general practitioners' referral rates to consultants. J R Coll Gen Pract. 1987 Aug;37(301):350–353. [PMC free article] [PubMed]
  • Wilkin D, Smith A. Explaining variation in general practitioner referrals to hospital. Fam Pract. 1987 Sep;4(3):160–169. [PubMed]
  • Moore AT, Roland MO. How much variation in referral rates among general practitioners is due to chance? BMJ. 1989 Feb 25;298(6672):500–502. [PMC free article] [PubMed]
  • Hull FM, Westerman RF. Referral to medical outpatients department at teaching hospitals in Birmingham and Amsterdam. Br Med J (Clin Res Ed) 1986 Aug 2;293(6542):311–314. [PMC free article] [PubMed]
  • Black D. The paradox of medical care. J R Coll Physicians Lond. 1979 Apr;13(2):57–65. [PubMed]
  • Glenn JK, Hofmeister RW, Neikirk H, Wright H. Continuity of care in the referral process: an analysis of family physicians' expectations of consultants. J Fam Pract. 1983 Feb;16(2):329–334. [PubMed]
  • Dornan C, Fowler G, Mann JI, Markus A, Thorogood M. A community study of diabetes in Oxfordshire. J R Coll Gen Pract. 1983 Mar;33(248):151–155. [PMC free article] [PubMed]
  • Grace JF, Armstrong D. Reasons for referral to hospital: extent of agreement between the perceptions of patients, general practitioners and consultants. Fam Pract. 1986 Sep;3(3):143–147. [PubMed]
  • Metcalfe DH. Health services in the United Kingdom: trends in provision and utilization 1971-80. Fam Pract. 1984 Sep;1(3):140–146. [PubMed]
  • McCormack TT, Collier JA, Abel PD, Collins CD, Ritchie WN. Attitudes to follow-up after uncomplicated surgery--hospital out-patients or general practitioner? Health Trends. 1984 May;16(2):46–47. [PubMed]
  • Bulpitt CJ, Daymond MJ, Dollery CT. Community care compared with hospital outpatient care for hypertensive patients. Br Med J (Clin Res Ed) 1982 Feb 20;284(6315):554–556. [PMC free article] [PubMed]
  • Petrie JC, Robb OJ, Webster J, Scott AK, Jeffers TA, Park MD. Computer assisted shared care in hypertension. Br Med J (Clin Res Ed) 1985 Jun 29;290(6486):1960–1962. [PMC free article] [PubMed]
  • Degoulet P, Menard J, Vu HA, Golmard JL, Devries C, Chatellier G, Plouin PF. Factors predictive of attendance at clinic and blood pressure control in hypertensive patients. Br Med J (Clin Res Ed) 1983 Jul 9;287(6385):88–93. [PMC free article] [PubMed]
  • West RR, McKibbin B. Shortening waiting lists in orthopaedic surgery outpatient clinics. Br Med J (Clin Res Ed) 1982 Mar 6;284(6317):728–730. [PMC free article] [PubMed]
  • Stewart IC, McHardy GJ. Audit in a chest clinic. Health Bull (Edinb) 1984 Jan;42(1):45–50. [PubMed]
  • Stamp EJ, Jones SJ, Ryrie DR, Hedley AJ. Oral anticoagulants: a cost-effectiveness approach. J R Coll Physicians Lond. 1985 Apr;19(2):105–108. [PubMed]
  • Rees Gareth J G. Cost-effectiveness in oncology. Lancet. 1985 Dec 21;2(8469-8470):1405–1408. [PubMed]
  • Cochrane JP, Williams JT, Faber RG, Slack WW. Value of outpatient follow-up after curative surgery for carcinoma of the large bowel. Br Med J. 1980 Mar 1;280(6214):593–595. [PMC free article] [PubMed]
  • Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. [PubMed]
  • Finlay AY, Kelly SE. Psoriasis--an index of disability. Clin Exp Dermatol. 1987 Jan;12(1):8–11. [PubMed]
  • Grace JF, Armstrong D. Referral to hospital: perceptions of patients, general practitioners and consultants about necessity and suitability of referral. Fam Pract. 1987 Sep;4(3):170–175. [PubMed]
  • Kiff RS, Sykes PA. Who undertakes the consultations in the outpatient department? Br Med J (Clin Res Ed) 1988 May 28;296(6635):1511–1512. [PMC free article] [PubMed]
  • Mageean RJ. Study of "discharge communications" from hospital. Br Med J (Clin Res Ed) 1986 Nov 15;293(6557):1283–1284. [PMC free article] [PubMed]
  • Harding J. Study of discharge communications from hospital doctors to an inner London general practice. J R Coll Gen Pract. 1987 Nov;37(304):494–495. [PMC free article] [PubMed]
  • Marsh GN. Are follow-up consultations at medical outpatient departments futile? Br Med J (Clin Res Ed) 1982 Apr 17;284(6323):1176–1177. [PMC free article] [PubMed]
  • Fraser RC, Patterson HR, Peacock E. Referrals to hospitals in an East Midlands city--a medical audit. J R Coll Gen Pract. 1974 May;24(142):304–319. [PMC free article] [PubMed]
  • Stewart IC, McHardy GJ. Audit in a chest clinic. Health Bull (Edinb) 1984 Jan;42(1):45–50. [PubMed]
  • Shaw CD. The problems of out-patient visits. Health Trends. 1981 Nov;13(4):107–108. [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners