Background: This study describes a system for prospectively reviewing non-urgent consultation or referral requests in a family practice residency program.
Methods: A committee composed of four rotating family physicians met weekly during a 22-month period to review all non-urgent proposed consultations. The committee either approved consultations or made other recommendations to the primary care physician for clinical management. Data were prospectively recorded to determine what types of referrals were most commonly made and approved, and if the number of consultations changed after the system was instituted.
Results: The committee reviewed 930 non-urgent consultation requests. The consultation request rate was 2.5 per 100 patients seen. The number of consultation requests declined significantly over the study period. (P = .0007) Seventy-two percent of consultation requests were approved; 28% were not and resulted in recommendations for alternate management. Non-approval was most likely for referrals to specialists in podiatry, rheumatology, endocrinology, neurology, gastroenterology, cardiology, and allergy. The approval rate for consultations was not significantly related to patient age, sex, or type of health insurance. Patients with multiple consultation requests were more likely to have a prepaid health insurance plan or governmental insurance than private insurance.
Conclusions: Prospective review of consultations and referrals can result in a decrease in the rate of consultations and referrals made by family physicians. Alternative management can frequently be recommended. Potential benefits of this system may include significant medical care cost savings and education for physicians.