ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2007
Patient pressure for referral for headache: a qualitative study of GPs' referral behaviour.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 1 of them a synthesis that pooled it.
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Who cites it
41 citing papers in PubMed, 1 synthesis or guideline pooled it, 77 citations in OpenAlex.
- Moderators uncertainty tolerance (UT) in healthcare: a systematic review.Advances in health sciences education : theory and practice · 2023Pooled it
- Education Research: Explaining Neurophobia in Medical Students: A Comparison With Math Anxiety.Neurology. Education · 2026Article
- Tolerance of ambiguity and psychological wellbeing in newly qualified doctors: An analysis over multiple time points.Medical education · 2025Article
- Article
- Identifying Gaps in Predoctoral Craniofacial Education.Dentistry journal · 2025Article
- Evaluating headache referral trends and practices across different settings in neurology clinics: insights from an international cross-sectional multicenter study.Journal of oral & facial pain and headache · 2025Article
- Referral trajectories in patients with vertigo, dizziness and balance disorders and their impact on health-related quality of life and functioning: results from the longitudinal multicenter study MobilE-TRA.Journal of neurology · 2022Article
- Diagnostic Values of Red Flags and a Clinical Prediction Score for Emergent Intracranial Lesions in Non-Traumatic Pediatric Headaches.Children (Basel, Switzerland) · 2022Article
- Isolated headache is not a reliable indicator for brain cancer: the 2-week wait pathway for suspected CNS malignancies.Clinical medicine (London, England) · 2021Article
- Observational
- Should GPs have direct access to imaging for headache? A qualitative study of patients' views in the UK.BMJ open · 2019Article
- Not Just a Headache: Qualitative Study About Web-Based Self-Presentation and Social Media Use by People With Migraine.Journal of medical Internet research · 2019Article
- Practice variation in the use of tests in UK primary care: a retrospective analysis of 16 million tests performed over 3.3 million patient years in 2015/16.BMC medicine · 2018Article
- Association of migraines with brain tumors: a nationwide population-based study.The journal of headache and pain · 2018Article
- Primary care management of headaches and how direct-access MRI fits: a qualitative study of UK general practitioners' views.BMJ open · 2017Article
- Achieving a balance between the physical and the psychological in headache.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Article
- Emergency medical triage decisions are swayed by computer-manipulated cues of physical dominance in caller's voice.Scientific reports · 2016Article
- The association between general practitioner participation in joint teleconsultations and rates of referral: a discrete choice experiment.BMC family practice · 2015Article
- Decision making and referral from primary care for possible lung and colorectal cancer: a qualitative study of patients' experiences.The British journal of general practice : the journal of the Royal College of General Practitioners · 2014Article
- Examining the variation in GPs' referral practice: a cross-sectional study of GPs' reasons for referral.The British journal of general practice : the journal of the Royal College of General Practitioners · 2014Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHeadache accounts for up to a third of new specialist neurology appointments, although brain lesions are extremely rare and there is little difference in clinical severity of referred patients and those managed in primary care. This study examines influences on GPs' referral for headache in the absence of clinical indicators. DESIGN OF STUDY: Qualitative interview study.
settingEighteen urban and suburban general practices in the South Thames area, London.
methodPurposive sample comprising GPs with varying numbers of referrals for headache over a 12-month period. Semi-structured interviews with 20 GPs were audio taped. Transcripts were analysed thematically using a framework approach.
resultsAll GPs reported observing patient anxiety and experiencing pressure for referral. Readiness to refer in response to pressure was influenced by characteristics of the consultation, including frequent attendance, communication problems and time constraints. GPs' accounts showed variations in individual's willingness or 'resistance' to refer, reflecting differences in clinical confidence in identifying risks of brain tumour, personal tolerance of uncertainty, views of patients' 'right' to referral and perceptions of the therapeutic value of referral. A further source of variation was the local availability of services, including GPs with a specialist interest and charitably-funded clinics.
conclusionReferral for headache is often the outcome of patient pressure interacting with GP characteristics, organisational factors and service availability. Reducing specialist neurological referrals requires further training and support for some GPs in the diagnosis and management of headache. To reduce clinical uncertainty, good clinical prediction rules for headache and alternative referral pathways are required.
Indexed as
Identifiers
17244421PMC2032697W156458044What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.