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The effect of deprivation on variations in general practitioners' referral rates: a cross sectional study of computerised data on new medical and surgical outpatient referrals in Nottinghamshire

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7092.1458 (Published 17 May 1997) Cite this as: BMJ 1997;314:1458
  1. Julia Hippisley-Cox (julia.h-cox{at}nottingham.ac.uk), lecturer in general practicea,
  2. Carolyn Hardy, researcher in general practicea,
  3. Mike Pringle, professor of general practicea,
  4. Katherine Fielding, lecturer in medical statisticsb,
  5. Robin Carlisle, research lecturer in general practicea,
  6. Clair Chilvers, professor of epidemiologyb
  1. a Department of General Practice, Medical School, Queen's Medical Centre, Nottingham NG7 2UH
  2. b Trent Institute for Health Services Research, Medical School, Queen's Medical Centre
  1. Correspondence to: Dr Hippisley-Cox
  • Accepted 11 March 1997

Abstract

Objective: To determine the effect of deprivation on variations in general practitioners' referral rates using the Jarman underprivileged area (UPA(8)) score as a proxy measure.

Design: Cross sectional survey of new medical and surgical referrals from general practices to hospitals (determined from hospital activity data).

Setting: All of the 183 general practices in Nottinghamshire and all of the 19 hospitals in Trent region.

Main outcome measures: The relation between the referral rates per 1000 registered patients and the practice population's UPA(8) score (calculated on the basis of electoral ward), with adjustment for the number of partners, percentage of patients aged over 65 years, and fundholding status of each practice.

Results: There was a significant independent association between deprivation, as measured by the UPA(8) score, and high total referral rates and high medical referral rates (P<0.0001). The UPA(8) score alone explained 23% of the total variation in total referral rates and 32% of the variation in medical referral rates. On multivariate analysis, where partnership size, fundholding status, and percentage of men and women aged over 65 years were included, the UPA(8) score explained 29% and 35% of the variation in total and medical referral rates respectively.

Conclusion: Of the variables studied, the UPA(8) score was the strongest predictor of variations in referral rates. This association is most likely to be through a link with morbidity, although it could reflect differences in patients' perceptions, doctors' behaviour, or the use and provision of services.

Key messages

  • Significant associations exist between deprivation as measured by the UPA(8) score and high total and medical referral rates

  • On multivariate analysis, where partnership size, fundholding status, percentage of men and women aged over 65 years were included, the UPA(8) score explained 29% and 35% of the variation in total and medical referral rates respectively

  • Of the variables studied, the UPA(8) score is the strongest predictor of variations in medical referral rates

  • Studies of general practitioners' workload and activity need to include deprivation scores such as the UPA(8) score

Footnotes

    • Accepted 11 March 1997
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