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The demand for surgery: an analysis of referrals from Australian general practitioners

Gruen, Russell L., Knox, S., Carson, P., O'Rourke, I. C., Britt, H. and Bailie, Ross S. (2004). The demand for surgery: an analysis of referrals from Australian general practitioners. ANZ Journal of Surgery,74(10):863-868.

Document type: Journal Article
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Title The demand for surgery: an analysis of referrals from Australian general practitioners
Author Gruen, Russell L.
Knox, S.
Carson, P.
O'Rourke, I. C.
Britt, H.
Bailie, Ross S.
Journal Name ANZ Journal of Surgery
Publication Date 2004
Volume Number 74
Issue Number 10
ISSN 1445-1433   (check CDU catalogue open catalogue search in new window)
Start Page 863
End Page 868
Total Pages 6
Place of Publication Australia
Publisher Wiley-Blackwell Publishing Asia
Field of Research 1103 - Clinical Sciences
HERDC Category C1 - Journal Article (DEST)
Abstract Background: Optimal planning for surgical training and the surgical workforce requires knowledge of the need and demand for surgical care in the community. This has previously relied on indirect indicators, such as hospital throughput. We aimed to describe referrals from general practitioners (GPs) to surgeons in Australia using a classification of surgical disorders developed especially for primary care settings.

Methods: Terms in the International Classification of Primary Care Version 2-Plus were reclassified into categories delineated by specialist surgeons, resulting in the Surgical Nosology In Primary-care Settings (SNIPS). Referrals to surgeons were analysed using data on 303 000 patient encounters by a random sample of 3030 GPs involved in the Bettering the Evaluation and Care of Health (BEACH) study.

Results: Thirty-two per cent (143 013) of all problems were classified as potential surgical problems, of which 9.5% (13 570) were referred to surgeons at an overall rate of 44.8 referrals per 1000 GP encounters. Patients with surgical problems were significantly older than the overall general practice patient population. Women and patients with health care cards were significantly less likely than men and patients without health care cards to be referred when a surgical problem was managed by the GP. Forty-two per cent of all surgical referrals were accounted for by the following categories: skin lesions, skin infection/injury, upper gastrointestinal, breast lumps/cancer, spine, knee arthritis/pain, knee injury/instability, infective and non-infective ear disorders. Many commonly referred problems are usually managed as outpatients.

Conclusions: The data from this study may have application for surgical workforce planning and ensuring trainees receive adequate exposure to commonly referred conditions. The classification system (SNIPS) may be useful for future research concerning the interface between primary care and specialist surgical practice.
Keywords classification
family practice
health service needs and demand
referral and consultation
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