The role of contextual factors in decision-making by General Practitioners on paediatric referral to the Emergency Department in Ireland: A Discrete Choice Experiment. (June 2023)

• Record Type: Journal Article
• Authors: McDonnell, Thérèse; Nicholson, Emma; Bury, Gerard; Collins, Claire; Conlon, Ciara; De Brún, Aoife; Doherty, Edel; McAuliffe, Eilish
• Is Part Of: Health policy. Volume 132(2023)
• Publication Date: 2023-06
• Subjects: Discrete choice experiment -- General practice -- Emergency department -- Referral -- Decision-making; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2023.104813
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: GPs consider contextual factors on referring paediatric patients to the emergency department (ED). Repeat presentations and parental lack of capacity to cope are most influential. A parent requesting a referral may also lead to a referral. Access to a paediatric outpatient clinic may avoid an ED referral. Friday presentations are more likely to be referred to the ED. Abstract: A General Practitioner's (GP) decision to refer a patient to the emergency department (ED) requires consideration of a multitude of factors, and significant variation in GP referral patterns to secondary care has been recorded. This study examines the contextual factors that influence GPs when referring a paediatric patient with potentially self-limiting clinical symptoms to the ED. Utilizing a discrete choice experiment, survey data was collected from GPs in Ireland ( n = 142) to elicit factors influencing this decision across five attributes: time/day of visit, repeat presentation, parents' capacity to cope, parent requesting a referral, and access to a paediatric outpatient clinic/day unit. Using mixed logit models, all attributes were statistically significant, with repeat presentation and parents lacking the capacity to cope identified as the strongest contextual factors leading to the decision to refer to the ED. There has been limited exploration of this decision-making process and this study uses a robust design to identify and rank contextual attributes. Enhanced awareness of contextual factors on referral decision-making is crucial to understanding patterns of paediatric unscheduled healthcare and to planning services that respond to parent's and children's needs, whilst allowing GPs to make decisions in the best interest of the child.