The objective of this study is to determine how @entity1 age, sex, @entity1011 level, and comorbidity affect referral decisions for the treatment of @entity454 ( @entity454 ) and whether these decisions are affected by physician characteristics in three countries: Canada, the United States, and Britain. A vignette-based questionnaire was mailed to a random sample of family physicians in Ontario, Canada (1,818 physicians); all family physicians in the state of New York (1,814 physicians); and a sample of general practitioners from the south of England (2,228 physicians) in 1996. Physicians were presented with clinical scenarios involving a @entity1 with varying degrees of @entity177 and a complicating comorbidity, including @entity951 , @entity6 , @entity5 , @entity1032 , or socioeconomic circumstances. They were asked to indicate the likelihood of referral. Half the physicians received a questionnaire describing a male @entity1 , and half, a female @entity1 . Mean @entity1011 levels at which physicians would refer were 260 micromol/L for British physicians, 297 micromol/L for Canadian physicians, and 340 micromol/L for American physicians. No difference in referral rates was found based on the sex of the @entity1 or physician. Sixty-five percent of American and Canadian physicians would refer regardless of @entity1 age, but only 49% of British physicians would do so. Family physicians in the United States, Canada, and Britain function as gatekeepers for @entity1 with @entity454 . They are less likely to refer based on increasing severity of comorbid conditions. They also discriminate based on age, but not sex.

XXXX : factors affecting referral decisions by family physicians in Canada, the United States, and Britain.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity1032 :: ('MESH:D008607', 'Disease') :: ['mental illness'] @entity6 :: ('MESH:D003920', 'Disease') :: ['diabetes'] @entity5 :: ('MESH:D009369', 'Disease') :: ['cancer'] @entity177 :: ('MESH:D051437', 'Disease') :: ['renal insufficiency'] @entity951 :: ('MESH:D000787', 'Disease') :: ['angina'] @entity1011 :: ('MESH:D003404', 'Chemical') :: ['creatinine'] @entity454 :: ('MESH:D007676', 'Disease') :: ['end-stage renal disease', 'ESRD']
@entity454 :: (MESH:D007676,Disease) :: ['End-stage renal disease']
