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Gender and age concordance between patient and general practitioner; associations with referral behaviour.

Eggermont, D., Kunst, A., Hek, K., Verheij, R. Gender and age concordance between patient and general practitioner; associations with referral behaviour. British Journal of General Practice: 2022
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Background
Appropriate referral from primary to secondary care is essential for maintaining a health care system that is accessible and cost-effective. Social concordance can affect the doctor-patient interaction and possibly also referral behaviour.

Aim
Investigate the association of gender concordance and age concordance on referral rates in primary care in the Netherlands.

Design and setting
We used electronic health records data (n=24.841) from 65 GPs in the Netherlands, containing referral information and combined that with demographics of GPs and patients to investigate factors associated with referral likelihood.

Methods
Health records covered 16 different symptoms/diagnoses, categorized as 'gender sensitive', 'age sensitive', 'both age and gender sensitive' or 'neutral' based on Delphi consensus. Multi-level logistic regressions were performed to calculate the associations of gender and age concordance with referral status.

Results
Overall, 16.8% of patients were referred to a medical specialist. The female-male dyad (GP-patient) was associated with a higher referral likelihood (OR 1.14, CI: 1.02-1.27, P=0.02) compared to the female-female dyad. Gender discordance was associated with a higher referral likelihood regarding consultations involving 'gender-sensitive' symptoms/diagnoses (OR 1.21, CI: 1.02-1.44, P=0.03) and in duo/group practices (OR 1.08, CI: 1.00-1.16, P=0.05). Age concordance was not a significant predictor of referrals in the main model nor in subgroup analyses.

Conclusion
Gender discordance was associated with a higher likelihood of referring. This study adds to the evidence that gender concordance affects decisions to refer, particularly with respect to symptoms/diagnoses that can be regarded as 'gender sensitive'.