Referral quality and the cooperation between hospital physicians and general practice: the role of physician and primary care factors.

AIMS: It has been shown that referral letters from GPs often are of poor quality, but research in this field is scarce, and few efforts have been made to investigate the factors that may help explain the variation in referral quality.
METHODS: Combining a survey among 1298 Norwegian hospital physicians (response rate: 52%) with information on the hospitals and the communities they are serving, this study investigates how they view the general quality of patient referrals received from GPs, and the extent to which insufficient information in referrals and inappropriate referrals is considered a problem for cooperation with GPs.
RESULTS: Only 15.6% of the hospital physicians perceived the quality of the referrals to be "usually good", and both lack of information in referrals and inappropriate referrals are seen as important barriers to cooperation with GPs. Of the individual factors, former GP practice is associated with a positive view on referral quality, while regular meetings between hospital physicians and GPs seem to reduce the problems of inappropriate and incomplete referrals. Furthermore, both average number of patients on GPs' lists and lack of free capacity in nursing and care institutions in the hospital catchment area was found to be negatively associated with perceived referral quality.
CONCLUSIONS: There is a need to increase the knowledge on how contextual, institutional and professional factors affect coordination of care. The main contribution of this study lies in the attempt to address the macro and micro barriers of obtaining good referral care.