SynthesisScandinavian journal of primary health care2011
The effects of gatekeeping: a systematic review of the literature.
Synthesis in Scandinavian journal of primary health care, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 71 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
71 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Evidence on bringing specialised care to the primary level-effects on the Quadruple Aim and cost-effectiveness: a systematic review.BMC health services research · 2024Pooled it
- Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Pooled it
- Using general practitioners to recruit individuals with low socioeconomic position to preventive health checks is feasible: a cross sectional study.Scandinavian journal of primary health care · 2019Trial
- Stroke recognition and early care pathways following telephone triage in out-of-hours primary care: a register-based study from the Central Denmark Region.Scandinavian journal of primary health care · 2026Article
- Primary care determinants for timely diagnosis of dementia.Family medicine and community health · 2026Article
- [A primary care system in Germany: evidence, opportunities, and implementation].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2026Review
- [Patient management and patient autonomy: An ethical tension?]Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2026Article
- Assigned But Not Anchored: A Study of Primary Care Provider Utilization Among Covered California Enrollees.Journal of general internal medicine · 2026Article
- Changes in Referral Rates After the Mandate of Charging Additional Fees for Non-referral First Visits: A Controlled Interrupted Time-series Analysis.Journal of epidemiology · 2026Article
- Primary Care or Primary Problem? Aligning Access Pathways with Patient Needs Across the Care Continuum.Journal of market access & health policy · 2026Article
- Bridging crisis recovery and long-term transformation of the health system in Lebanon: evidence from key informant interviews and global lessons.BMC health services research · 2026Article
- Urgent care utilization patterns in Switzerland: a population-based cross-sectional study.BMC health services research · 2026Article
- Polydoctoring and health outcomes among the very old population with multimorbidity: a retrospective cohort study in Japan.Scientific reports · 2025Article
- Article
- The Influence of Cognitive and Affective Trust on the Utilization of Family Doctor Services: A Chinese Cross-Sectional Survey Based on McAllister's Theory.Patient preference and adherence · 2025Article
- Gatekeeping or Provider Choice for Sustainable Health Systems? A Literature Review on Their Impact on Efficiency, Access, and Quality of Services.Journal of market access & health policy · 2024Review
- Diagnostic process of cancer in a health system without gatekeeping: a single centre survey analysis.Primary health care research & development · 2024Article
- [Ensuring primary care in Germany-findings from a quantitative survey of general practitioners].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2024Article
- The association between family doctor contract services and the health of middle-aged and older people in China: an instrumental variables analysis.Scientific reports · 2024Article
- The impact of family doctor contract services on the utilization of and satisfaction with primary health care among Chinese residents: A cross-sectional study.Journal of family medicine and primary care · 2024Article
11 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the effects of physician-centred gatekeeping on health, health care utilization, and costs by conducting a systematic review of the literature.
methodsSystematic search in PubMed (MEDLINE and Pre-MEDLINE), EMBASE, and the Cochrane Library, from the databases' respective inception dates up to January 2010, using the search words "gatekeeping", "gatekeeper*", "first contact", and "self-referral". We included RCTs, CCTs, cohort studies, CBAs, and interrupted time-series. We included only studies in which the gatekeeper function was exercised by a physician and that reported health and patient-related outcomes including quality of life and satisfaction, quality of care, health care utilization, and/or economic outcomes (e.g. expenditures or efficiency). Selection was made independently by two reviewers and discrepancies were solved by consensus after discussion. Data on target population, intervention, additional interventions, study results, and methodological quality were extracted. Methodological quality was assessed independently by two reviewers following the previously defined criteria. Discrepancies were solved by consensus after discussion.
resultsThis review includes 26 studies in 32 publications. The majority of studies (62%) reported data from the United States and in most gatekeeping was associated with lower utilization of health services (up to -78%) and lower expenditures (up to -80%). However, there was great variability in the magnitude and direction of the differences.
conclusionOverall, the evidence regarding the effects of gatekeeping is of limited quality. Many studies are available regarding the effects on health care utilisation and expenditures, whereas effects on health and patient-related outcomes have been studied only exceptionally and are inconclusive.
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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.