Date of Award


Degree Type


Degree Name

Master of Science


Epidemiology and Biostatistics


Dr. Amardeep Thind

Second Advisor

Dr. Stewart Harris

Third Advisor

Dr. Yun-Hee Choi


Objective: Determine the referral rate and the visit and patient factors associated with specialist referral for patients with type 2 diabetes. Methods: Sample consisted of 9,443 patient-physician visits from eight family practice groups in southwestern and central Ontario. GEE was used for the regression analysis. Results: The referral rate was 3.7 referrals per 100 patient visits. The odds of referral decreased if a visit occurred with a female patient and if an ACR measurement was not available at the visit. A one year increase in the number of years with the family physician resulted in a lower odds of referral. The odds of referral increased if the patient had a specialist appointment in the previous two years, if lifestyle counseling occurred and if a neuropathy examination was performed. Conclusions: Further research should assess the influence of visit level factors on decision making. Guidelines for specialist referral should also be considered.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.