Abstract
BACKGROUND: Intermediate care, which is provided by community hospitals, is increasingly seen as one way of reducing pressure on secondary care. However, despite evidence of wide variation, there is little literature describing how general practitioners (GPs) use these hospitals. Because of the control they have over decisions to admit, development of these units depends on the cooperation of GPs. AIM: To identify and understand the factors influencing the decision to admit to a community hospital. DESIGN OF STUDY: A qualitative interview study. SETTING: Twenty-seven practitioners from ten practices supporting five community hospitals in one region of Tayside, Scotland Secondary support was identical for all sites. METHOD: In-depth interviews were conducted with a purposive sample of GPs representing those who had the most and the least use of the five community hospitals. A qualitative anaysis was performed to determine thefactors that practitioners considered important when making decisions about admission. Results were presented to the study group for validation. RESULTS: All admissions required adequate capacity in the community hospital system. Primarily social admissions were straight forward requiring only adequate hospital nursing, and GP capacity. More typical admissions involving social and medical needs required consideration of the professional concerns and the personal influences on the doctor as well as the potential benefits to the patient. As medical complexity increased the doctor's comfort/discomfort became the deciding factor. CONCLUSION: Provided there was adequate capacity, the GPs perceived the level of comfort to be the prime determinant of which patients are admitted to community hospitals and which are referred to secondary care.
Full Text
The Full Text of this article is available as a PDF (76.2 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aaraas I., Fylkesnes K., Førde O. H. GPs' motives for referrals to general hospitals: does access to GP hospital beds make any difference? Fam Pract. 1998 Jun;15(3):252–258. doi: 10.1093/fampra/15.3.252. [DOI] [PubMed] [Google Scholar]
- Bradley C. P. Uncomfortable prescribing decisions: a critical incident study. BMJ. 1992 Feb 1;304(6822):294–296. doi: 10.1136/bmj.304.6822.294. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Coulter A., Noone A., Goldacre M. General practitioners' referrals to specialist outpatient clinics. II. Locations of specialist outpatient clinics to which general practitioners refer patients. BMJ. 1989 Jul 29;299(6694):306–308. doi: 10.1136/bmj.299.6694.306. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Grant J. A. Contribution of general practitioner hospitals in Scotland. Br Med J (Clin Res Ed) 1984 May 5;288(6427):1366–1368. doi: 10.1136/bmj.288.6427.1366. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Newton J., Hayes V., Hutchinson A. Factors influencing general practitioners' referral decisions. Fam Pract. 1991 Dec;8(4):308–313. doi: 10.1093/fampra/8.4.308. [DOI] [PubMed] [Google Scholar]
- Pope C., Mays N. Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ. 1995 Jul 1;311(6996):42–45. doi: 10.1136/bmj.311.6996.42. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ramaiah S. Community hospitals in the new NHS. BMJ. 1994 Feb 19;308(6927):487–488. doi: 10.1136/bmj.308.6927.487. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Seamark D., Moore B., Tucker H., Church J., Seamark C. Community hospitals for the new millennium. Br J Gen Pract. 2001 Feb;51(463):125–127. [PMC free article] [PubMed] [Google Scholar]
- Tomlinson J., Raymond N. T., Field D., Botha J. L. Use of general practitioner beds in Leicestershire community hospitals. Br J Gen Pract. 1995 Aug;45(397):399–403. [PMC free article] [PubMed] [Google Scholar]
- Wilkin D., Smith A. Explaining variation in general practitioner referrals to hospital. Fam Pract. 1987 Sep;4(3):160–169. doi: 10.1093/fampra/4.3.160. [DOI] [PubMed] [Google Scholar]