Neurology referral patterns.

To examine the indications for referral of patients to neurologists, a survey was conducted of 88 such referrals by general internists in an HMO. In approximately one third of all referrals, the neurologist's advice regarding diagnosis and treatment was of minor or no importance. Instead, such referrals were often responsive to patient and family demands or focused upon the necessity for neuroimaging, even when the likely diagnosis and required treatment were already evident. Referral rates in HMO practice are strongly influenced by the practice styles of primary care providers. The authors conclude that a case manager ("gatekeeper") mechanism in competitive medical plans that excludes patient self-referrals may have a greater effect upon total (and surgical) specialty care, compared with the volume of services provided by medical specialists such as neurologists.