Specialty referral completion among primary care patients: Results from the ASPN referral study

Christopher B. Forrest, Efrat Shadmi, Paul A. Nutting, Barbara Starfield

Research output: Contribution to journalArticlepeer-review


PURPOSE: This study describes referral completion from the perspectives of patients and primary care physicians and identifies predictors of adherence to the referral recommendation. METHODS: We observed a cohort of 776 referred patients from the offices of 133 physicians in 81 practices and 30 states. Referring physicians and patients completed self-administered questionnaires at the time of the referral decision and 3 months later. RESULTS: Physicians reported that 79.2% of patients referred had a specialist visit, and 83.0% of patients indicated they completed the referral. The most common reasons for not completing the referral were "lack of time" and patient belief that the "health problem had resolved." The κ statistic for patient-physician agreement on referral completion was 0.34, indicating only fair concordance. Patients in Medicaid plans were less likely than others to complete the referral, and more likely to experience a health plan denial. A longer duration of the patient relationship with the primary care physician and physician/staff scheduling of the specialty appointment were both positive predictors of referral completion. CONCLUSIONS: About 8 in 10 patients referred from primary care complete a specialty referral within 3 months. Findings from this study suggest that referral completion rates may be increased by assisting patients with scheduling their specialty appointments and promoting continuity of care.

Original languageEnglish
Pages (from-to)361-367
Number of pages7
JournalAnnals of Family Medicine
Issue number4
StatePublished - Jul 2007


  • Appointment adherence
  • Continuity of patient care
  • Delivery of health care
  • Patient acceptance of health care
  • Practice-based research
  • Primary health care
  • Referral and consultation

ASJC Scopus subject areas

  • Family Practice


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