Does reduction in general practitioners ’ use of diagnostic tests lead to more hospital referrals?

SUMMARY Background. Individual feedback on general practitioners' requests fo r tests can im prove the q u a lity o f th e ir test ordering behaviour. Little is known o f the side effects on hospital referral behaviour when the use o f tests is reduced through feedback. Aim. A study was undertaken to explore changes in general practitioners' hospital referral rates in a region where their use o f diagnostic tests is reduced through feedback. Method. Trends in test requests and o f first referrals to spe­ cialists were compared among 64 general practitioners in the M aastricht region o f the N etherlands where routine feedback on test ordering b e h a v io u r is p ro vid e d b y the diagnostic coordinating centre. Results. Reduction in diagnostic test use was not accompan­ ied by a higher hospital referral rate, not even for special­ ties related to tests discussed in feedback. Good respond­ ers to feedback had decreased hospital referral rates in con­ trast to increased rates for poor responders (P<0.01). Conclusion. Reducing the volume o f general practitioners' diagnostic tests through feedback does n o t lead to more specialist referrals. Together with low er test use, fewer hos­ pital referrals were seen. K eyw ords: h o s p ita l based d ia g n o s tic tests; p a tte rn s o f work; utilization; referral o f patients to hospital for investi­ gation; referral rates.