Variation in general practitioner referral of patients with arterial disease.

Aim: To compare patterns of referral for arterial disease in two areas in the UK.

Methods: A postal questionnaire was used to survey general practitioner (GP) referral patterns for arterial disease. Questionnaires were sent to West Berkshire GPs in 1993 and 2000 and to Llantrisant GPs in 2000.

Results: A 70-year-old man with claudication at half a mile and an 80-year-old man with claudication at half a mile or 100 m were significantly more likely to be referred (P < 0.001) in West Berkshire in 2000 compared with 1993. This referral change also applied to an 80-year-old man with an aortic aneurysm who was more likely to be referred in 2000 (P < 0.01). Patients with gradual onset of rest pain were more likely to be referred urgently or as an emergency in 2000 (P < 0.05). When comparing the two areas in 2000, significant differences emerged in the likelihood of referring patients with intermittent claudication. Scepticism continues towards the value of AAA screening in West Berkshire with only about two-thirds of GPs thinking that it was of value. On the other hand in Llantrisant, 94% of GPs thought AAA screening was valuable (P < 0.001). There was a significant decrease in the number of GPs who felt that they would refer patients directly to a regional vascular centre in West Berkshire between the two time periods (P < 0.001). There was a difference in likelihood of referral to regional centres between the two areas in 2000 (33% versus 6%, P < 0.001).

Conclusions: Vascular referral patterns change with time and vary from one area to another. This has implications for planning vascular services.