Original Article
Interprofessional Referral Patterns in an Integrated Medical System

https://doi.org/10.1016/j.jmpt.2005.02.016Get rights and content

Objective

To determine the interreferral patterns among physicians and complementary and alternative medicine (CAM) providers in an independent practice association integrated medical system.

Method

Data from a 1-year period were collected on referral patterns, diagnosis, number of visits, cost, and qualitative aspects of patient care. The independent practice association provided care for approximately 12 000 patients.

Results

In the selected integrative network, there are those primary care physicians (PCPs) who refer and those who do not. Among those PCPs that refer to CAM, a preference is shown for a limited number of providers to whom they refer. Although doctors of chiropractic get more referrals, they are also more concentrated among selected providers than are doctors of oriental medicine.

Conclusion

This study shows the interreferral patterns among the PCP and CAM providers working within an integrated medical system. One effect of being in the network for doctors of chiropractic and doctors of oriental medicine might be the possible interreferrals between each other.

Section snippets

Organizational Challenges

Given this background, the practice of integrating CAM into mainstream medicine may be a challenging task. There is the professional historical animosity to consider, the elements of economic competition, and the lack of a clearly agreed upon principle on which to base the integration. It is clear that to be successful, there must be a considerable change in both professional attitudes and behavior.

For CAM to be integrated into a hospital setting requires not only a change in the attitudes of

Integrated Medicine Networks

There is general acceptance that to be meaningful and effective, CAM must be integrated at the clinical level.11 One of the primary organizational structures that have emerged for integrative medicine is the professional network. The level of integration in a network can be judged by the extent to which the CAM providers have access to other care services in the clinic and the extent to which their services are used.

Integrative medicine networks bring together distinct stakeholders. At the most

Methods

The state insurance commission in New Mexico has required coverage of CAM therapies by the conventional insurance industry. Integration of CAM therapies with conventional medicine for patients with medical insurance has been difficult and limited by variation in practice standards, diverse credentialing standards, lack of standardized referral patterns from the primary care provider, unreliable cost data, and lack of accurate billing codes.

Southwest Health Options is an independent practice

Referral Patterns of PCP to CAM Providers

In Table 1, we show the interreferral pattern between the providers in the network. It shows that for 1998 to 1999, 20% of the PCPs did not refer any patients to the DOMs, 66% referred 1 to 5 patients, 10% referred 6 to 10 patients, and 4% referred more than 10 patients. What is also clear is that certain PCPs account for the largest number of referrals. Of the total 124 referrals in this period, 4 PCP doctors made 36.2% of the referrals. Conversely, the top 3 DOMs who received referrals

Referral—DOMs to DCs

A second type of referral occurs between the CAM providers in the network. In Table 3, we show the referral pattern for DOMs and DCs. These results would suggest that in a network such as this, CAM providers do refer to each other and this in fact might be one of the benefits of being in such a network. Both the DOM providers and the DC have established referral patterns.

Discussion

The data resemble a good news/bad news scenario. For the good news, in this network, of the 42 PCP providers, only 3 are not linked through referrals to at least one CAM provider in the period studied. But the bad news, however, is that for most of the PCPs, the number of referrals is quite low. Any CAM provider relying solely on the referrals to generate a patient flow would not do very well in this network. This finding might reflect either the nature of the patient population, one which does

Conclusion

A network system, such as the one described here, may provide an administrative structure through which changes in physician attitudes can be realized in terms of actual referrals for their patients. Furthermore, it offers possibilities for the CAM providers to establish a referral network with each other.

Acknowledgments

The authors would like to thank Southern California University of Health Sciences student Matthew R. Lyon, BA, for his assistance with this project.

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