Table 2 Reasons, benefits and barriers to referral provided by general practitioners according to referral frequency
Reasons, benefits and barriers according to referral frequency | Overall (n = 325) | Infrequent referrals (n = 246) | Frequent referrals (n = 79) | P-value |  |
|---|---|---|---|---|---|
Reasons for referral | Â | Â | Â | Â | Â |
Diagnosis of diabetes | 34 (10) | 22 (8.9) | 12 (15.2) | 0.11 | Â |
Diabetes imbalance | 251 (77) | 182 (74) | 69 (87) | 0.01 | Â |
To start insulin therapy | 175 (54) | 119 (48) | 56 (71) | < 0.001 |  |
Initiation/reassessment/change of treatment | 116 (36) | 85 (35) | 31 (39) | 0.45 | Â |
To consolidate communication about therapeutics and compliance | 71 (22) | 47 (19) | 24 (30) | 0.04 | Â |
Complications of diabetes | 122 (38) | 93 (38) | 29 (37) | 0.86 | Â |
Therapeutic education | 58 (18) | 44 (18) | 14 (18) | 0.97 | Â |
Nutritional management | 49 (15) | 33 (13) | 16 (20) | 0.14 | Â |
To facilitate access to complementary examinations | 28 (8.6) | 20 (8.1) | 8 (10) | 0.58 | Â |
Other reasons | 12 (3.7) | 9 (3.7) | 3 (3.8) | 0.96 | Â |
Benefits expected from referral | Â | Â | Â | Â | Â |
To support therapeutic communication | 131 (40) | 95 (39) | 36 (46) | 0.27 | Â |
To get another perspective on the management of the patient | 206 (63) | 151 (61) | 55 (70) | 0.19 | Â |
To obtain advice before using new medication, such as SGLT-2 inhibitors(Gliflozins) | 154 (47) | 104 (42) | 50 (63) | 0.001 | Â |
To enable close monitoring by a multidisciplinary team (e.g. registered nurse, psychologist, dietician) | 93 (29) | 64 (26) | 29 (37) | 0.07 | Â |
Therapeutic education | 115 (35) | 86 (35) | 29 (37) | 0.78 | Â |
To facilitate the obtention of a complete check-up (carried out during a daytime or weekday hospitalization) | 141 (43) | 105 (43) | 36 (46) | 0.65 | Â |
Other benefits | 21 (6.5) | 18 (7.3) | 3 (3.8) | 0.27 | Â |
No benefits expected from referral | 1 (0.3) | 1 (0.4) | 0 (0.0) | 1.00 | Â |
Barriers to referral | Â | Â | Â | Â | Â |
Excessive wait time | 184 (57) | 138 (56) | 46 (58) | 0.74 | Â |
Distance | 44 (14) | 34 (14) | 10 (13) | 0.79 | Â |
Difficulties in communication with the diabetes specialist (e.g., telephone, absence of medical report) | 50 (15) | 38 (15) | 12 (15) | 0.96 | Â |
Disagreement/professional disagreement | 12 (3.7) | 10 (4.1) | 2 (2.5) | 0.53 | Â |
Patient refusal | 145 (45) | 99 (40) | 46 (58) | 0.01 | Â |
Fear of losing the patient | 7 (2.2) | 6 (2.4) | 1 (1.3) | 1.00 | Â |
Doubts about the added value of diabetologists compared to general practitioners | 69 (21) | 64 (26) | 5 (6.3) | < 0.001 |  |
Out-of-pocket fees applied by sector 2 (unregulated) practitionersa | 57 (18) | 44 (18) | 13 (16) | 0.77 | Â |
Other barriers | 23 (7.1) | 22 (8.9) | 1 (1.3) | 0.021 | Â |
No barrier | 35 (11) | 26 (11) | 9 (11) | 0.84 | Â |