Differences in the referral process from general practice to resident specialists in gynaecology depending on density of specialists and patients’ socioeconomic status

Abstract

AbstractBackground There are significant differences in the densities of resident specialists in gynaecology (RSGs) in various regions of Denmark. It is unclear whether this disparity affects gynaecological patients’ experience of the referral process and whether it differs in terms of their socioeconomic status (SES).Objective To examine gynaecological patients’ experiences of the referral process to an RSG concerning RSG density and patients’ SES.Design Cross-sectional questionnaire and registry-based study.Setting In Denmark, general practitioners (GPs) serve as gatekeepers of secondary care and are responsible for referrals to resident specialists as well as inpatient and outpatient hospital care.Subjects A total of 2917 patients who consulted an RSG participated in this study.Main outcome measurements Patients’ experiences of referral to an RSG, waiting times, involvement, and how they experienced the referral process.Results Patients who lived in the highest density RSG region were referred to an RSG more promptly after the onset of symptoms, had to visit their GP less frequently to obtain a referral to the RSG, and rarely received a gynaecological examination by their GP compared with those living in regions with lower RSG densities. Moreover, their waiting times were shorter, and more often, the patients themselves proposed to be referred to an RSG. The findings show that RSG density had a greater impact on women’s experiences than SES.Conclusion To allow equal access to specialist care, RSG density must be equal across all regions in the country.

Keywords

• Gatekeeping
• referral and consultation
• secondary care
• gynaecology
• health services accessibility
• health equity