Academic Journal
Beyond the gate: Referral style and utilisation of primary sector specialist care.
| Τίτλος: | Beyond the gate: Referral style and utilisation of primary sector specialist care. |
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| Συγγραφείς: | Pedersen SM; DaCHE, Department of Public Health, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark. Electronic address: samp@health.sdu.dk., Olsen KR; DaCHE, Department of Public Health, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark., Damslund N; DaCHE, Department of Public Health, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark., Allen T; DaCHE, Department of Public Health, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Manchester Centre for Health Economics, University of Manchester, 4.305 Jean McFarlane Building, Oxford Road, M13 9PL, Manchester, UK., Kjær T; DaCHE, Department of Public Health, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark. |
| Πηγή: | Social science & medicine (1982) [Soc Sci Med] 2026 Sep; Vol. 404, pp. 119512. Date of Electronic Publication: 2026 Jun 24. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Pergamon Country of Publication: England NLM ID: 8303205 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-5347 (Electronic) Linking ISSN: 02779536 NLM ISO Abbreviation: Soc Sci Med Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Oxford ; New York : Pergamon, c1982- |
| Ιατρικοί όροι (MeSH): | Referral and Consultation*/statistics & numerical data , Referral and Consultation*/standards , Primary Health Care*/statistics & numerical data , Practice Patterns, Physicians'*/statistics & numerical data, Diabetes Mellitus, Type 2/therapy ; Diabetes Mellitus, Type 2/complications ; Humans ; Denmark ; Female ; Middle Aged ; Aged ; Male ; Access to Primary Care ; Specialization ; Mass Screening ; General Practice |
| Περίληψη: | While variation in general practitioners' (GPs') practice style is well documented, little is known about how these differences shape patients' use of specialist care beyond formal gatekeeping regulation. Using population-wide data from Denmark, we exploit residual variation in referral rates measured at the GP practice level to classify practices as restrictive, moderate, or liberal referrers and link these patterns to chronic care among individuals with type 2 diabetes. We find that patients listed with restrictive-referring practices are significantly less likely to adhere to foot and eye screening for diabetes-related complications. This pattern is observed both for referral-required specialised services (foot screening: -2.5 pp) and direct-access specialised services (eye screening: -2.6 pp), suggesting that GP practice behaviour is associated with differences in utilisation of specialist care across access pathways to a varying degree. Differences in screening uptake are concentrated among practices at the extremes of the referral distribution suggesting that only particularly restrictive referral behaviours stand out. Additional analyses reveal that direct-access specialist care is not associated with variation by patients' socioeconomic status. We also explore heterogeneity in uptake by patient characteristics and find consistent evidence of differential uptake across services. Lower socioeconomic status, living alone, non-Danish ethnicity and comorbidity are all independently associated with lower screening uptake pointing to systematic social inequities in access that cannot be explained by differences in clinical need. Our findings highlight that variation in GP practice style extends beyond referral-dependent services, and is associated with differences in patients' chronic care behaviour more broadly. We highlight the importance of addressing both patient-level barriers and variation in GP practice styles to improve screening uptake and equity in chronic disease management. (Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| Competing Interests: | Declaration of competing interest None. |
| Contributed Indexing: | Keywords: Diabetes care; General practice; Inequity in access; Referral behaviour; Screening uptake |
| Entry Date(s): | Date Created: 20260625 Date Completed: 20260828 Latest Revision: 20260828 |
| Update Code: | 20260829 |
| DOI: | 10.1016/j.socscimed.2026.119512 |
| PMID: | 42349199 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1873-5347 |
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| DOI: | 10.1016/j.socscimed.2026.119512 |