Routine healthcare data identifies patient groups that do not follow up on referrals

Patients with COPD or an increased risk of cardiovascular disease do not always follow up on referrals from their general practitioners to specialist care, partly due to financial reasons. This is the conclusion of a new study on referral behavior in Dutch healthcare, conducted by Nivel and the Dutch National Health Care Institute (Zorginstituut Nederland), based on routine healthcare data.

COPD and Heart Patients Often Do Not Follow Up on Referrals

In the Netherlands, general practitioners refer patients with conditions such as COPD or an increased risk of cardiovascular disease to medical specialists in hospitals when necessary. However, a new study shows that a portion of these patients do not follow up on such referrals. Of those referred, 5.2% (COPD) and 8.8% (cardiovascular risk) did not visit a medical specialist within a year. Patients with COPD who had not yet used their mandatory deductibles were more likely to not follow up, or to follow up later. COPD patients who delayed follow-up (by one to three months) had a higher risk of being admitted to intensive care. Whether timely follow-up could have prevented these admissions requires further research.

Vulnerable groups are falling behind

In addition to financial factors, age and the presence of other chronic conditions also played a role in whether or not patients followed up on referrals. This raises questions about how to improve access to specialist care for these specific groups. While this study shows statistical correlations, it does not establish causal relationships. Therefore, the researchers advocate for follow-up studies to better understand whether patients who do not follow up on referrals ultimately fare worse, or whether their healthcare needs are being met in other ways, such as through primary care.

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The scientific article "Referral compliance and subsequent hospital admissions for COPD and cardiovascular disease in the Netherlands: a data linkage study" has been published in BMC Health Services Research.

About the study

This research was conducted within the joint research collaboration "Routine Healthcare Data for Appropriate Care" between Nivel and the Dutch National Health Care Institute. It is based on healthcare data collected from 2015 to 2020.