Gender and age concordance between patient and GP: an observational study on associations with referral behaviour

BACKGROUND: Appropriate referral from primary to secondary care is essential for maintaining a healthcare system that is accessible and cost-effective. Social concordance can affect the doctor–patient interaction and possibly also referral behaviour. AIM: To investigate the association of gender concordance and age concordance on referral rates in primary care in The Netherlands. DESIGN & SETTING: Electronic health records data (n = 24 841) were used from 65 GPs in The Netherlands, containing referral information, which was combined with demographics of GPs and patients to investigate factors associated with referral likelihood. METHOD: Health records covered 16 different symptoms and diagnoses, categorised 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 (odds ratio [OR] 1.14; 95% confidence interval [CI] = 1.02 to 1.27; P = 0.02) compared with the female–female dyad. Gender discordance was associated with a higher referral likelihood regarding consultations involving ‘gender-sensitive’ symptoms and diagnoses (OR 1.21; CI = 1.02 to 1.44; P = 0.03), and in duo and group practices (OR 1.08; 95% CI = 1.00 to 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 and diagnoses that can be regarded as ‘gender sensitive’.