Background: This paper defines and characterizes the self-referred patient, and answers key questions about self-referred patients' access to general medical and preventive care.
Method: Five years of data (July 1987 to June 1992) from The University of Iowa Hospitals and Clinics, a 900-bed tertiary care facility, were used to identify the demographics of self-referred patients. Routine data for all internal medicine patients were collected, as were questionnaire data from a sample of self-referred patients in 1991-92 from subspecialty clinics (172 patients) and general and emergency medicine services (136 patients). Questions were designed to obtain information concerning the decision for referral and the accessibility of general medical and preventive care.
Results: Thirty-five percent of the patients obtaining care in internal medicine were self-referred patients. This percentage increased from 26.5% to 34.5% of patients over the five-year period. More general medicine patients (45%) self-referred than did subspecialty service patients (32.5%). Sixty percent of these patients did not have a primary care physician. Almost 30% of these patients had no access to preventive care. Many of the self-referred patients (49%) were within an age range (41-75 years) most appropriate for preventive services.
Conclusion: This study characterizes a large and expanding group of self-referred patients presenting to a university hospital for care. Many of these patients did not have a primary care physician. Thus, there are opportunities to improve medical and preventive care for such patients.