Self-referral to physiotherapy: deprivation and geographical setting: Is there a relationship? Results of a national trial

ObjectivesTo establish the level of self-referral in urban, semi-rural and rural primary care settings, encompassing a range of deprivation, in Scotland.Design of studyQuasi-experimental.SettingTwenty-nine general practices throughout Scotland.ParticipantsThree thousand and ten patients (>16 years) and physiotherapists from throughout Scotland.MethodPractices were classified in terms of their location and level of deprivation (DEPCAT scores). Historical data were used to establish national referral rates in these settings. Self-referral was introduced in each setting and the proportions of patients referring themselves or being referred by their general practitioner (GP) were collated over a full year. A further category of ‘GP-suggested’ referral was also included.ResultsThere were different rates of referral according to setting (P < 0.001). A national adult referral rate of 53.5/1000 was identified. Rural areas experienced the highest rates (66/1000) of referral compared with urban (44.5/1000) and semi-rural (49/1000) settings. An overall ‘true’ self-referral rate of 22% was found. Rural areas experienced the highest levels of both self- and GP-suggested referrals (32% and 26%, respectively). An increase in total referral numbers was experienced in less than 20% of locations after introducing self-referral, all of which had a history of underprovision. Self-referrers came from all socio-economic settings, although differences were observed between the groups (P < 0.001).ConclusionsIntroducing self-referral does not appear to result in an increase in the overall referral rate when reasonable levels of service are already being provided in line with national rates according to geographical setting. Deprivation does not appear to exert a major influence on referral rates. However, the rate of self-referral in the long-term future is impossible to predict.