[Factors influencing professional decision making on acute hospital referral in the case of elderly patients with cognitive impairment among general practitioners (GPs) in The Netherlands: a qualitative study].

Background: Elderly patients with cognitive impairment have a limited life expectancy and are often acutely admitted to the hospital. Hospitalization can negatively affect their quality of life. More knowledge on considerations prior to these referrals is needed to improve care for these patients.

Aim: The aim of this research is to describe the aspects that can relate to the process of referring to the hospital in the acute situation by GPs in the case of elderly patients with cognitive impairment.

Method: Semi-structured interviews with 21 GPs from The Netherlands were conducted and afterwards transcribed verbatim. From these transcripts categories were extracted by using 131 focused codes according to the grounded theory.

Results: Twelve categories were constructed. Six categories relate to whether it is desirable to treat or refer. These are the illness itself, the patient's wishes, the condition of the patient, the patient's burden, the possibilities in the hospital, and the vision of the GP. Six categories relate to the options available to the GP. These include medical options, care options, available time and information, the support available to the GP, and referrals without involvement of the GP.

Conclusion: The referral of elderly patients with cognitive impairment is a complex process that is influenced by different types of factors. With these findings, specialists in hospitals, GPs, and policy makers can improve the quality of care for this group.