PROS Pearls:

* As part of the PROS Referral Process in Primary Care Study, investigators described how pediatricians refer patients to specialists, including frequency of referral decisions, reasons for referral, and types of referrals.

* Referrals to specialists are uncommon among pediatricians. Pediatricians refer children and adolescents to specialists during 2.3% of office visits (or 1 out of 40).

* Referrals made during telephone conversations with parents accounted for 27.5% of all referrals.

* Seventy-five percent of physicians had a referral rate less than or equal to 3.46% (range, 0-11.0%). After adjustment for patient characteristics, there was a 4.4-fold variation in referral rates.

* Getting advice on diagnosis or treatment from a specialist was the most common reason for referral (74% of referrals). Referral for medicolegal reasons or because the primary care physician had insufficient time to manage the patient's health problem was uncommon.

* Most referrals (53%) were made for new health problems and for 50 clinical conditions (especially chronic ear infections). Referrals were made to surgical subspecialists (52%), followed by medical subspecialists (28%), nonphysicians (11%), and mental health practitioners (8%). Also, in most cases (75%), physicians requested a consultation or a referral with shared management of the patient with the specialist.

* The researchers suggest that evidence-based guidelines on when to refer patients would be most useful for the 50 most commonly referred conditions reported in this study.