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

• Published in: Scandinavian journal of primary health care 2023-10, Vol.41 (4), p.435-444
• Main Authors: Laschke, Alexander D. L., Blaakær, Jan, Jensen, Charlotte Floridon, Larsen, Mette Bach
• Format: Article
• Language: English
• Subjects: Access; Density; Family physicians; Gatekeeping; General practice; gynaecology; Gynecology; health equity; health services accessibility; Inpatient care; Medical referrals; referral and consultation; secondary care; Socioeconomic factors; Socioeconomic status; Specialists; Waiting times; Women
• ISSN: 0281-3432; 1502-7724
• DOI: 10.1080/02813432.2023.2268663

BackgroundThere 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).ObjectiveTo examine gynaecological patients’ experiences of the referral process to an RSG concerning RSG density and patients’ SES.DesignCross-sectional questionnaire and registry-based study.SettingIn 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.SubjectsA total of 2917 patients who consulted an RSG participated in this study.Main outcome measurementsPatients’ experiences of referral to an RSG, waiting times, involvement, and how they experienced the referral process.ResultsPatients 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.ConclusionTo allow equal access to specialist care, RSG density must be equal across all regions in the country.