Referral wait times for specialties.

BackgroundAs Singapore adopts a population health approach under Healthier Singapore (Healthier SG), optimizing healthcare resources is crucial. We examined referral reasons (using large language models [LLM]), wait times, and analyse factors affecting referrals from primary to tertiary care.MethodsIn 2023, 1,063,646 patient visits from seven primary care clinics in Singapore were analysed. Patient demographics, clinic, physician characteristics, referral volumes and wait times were extracted. LLM Claude 3.5 Sonnet was utilized to identify and classify top referral reasons within the most frequently referred specialties based on referral notes. Chi-square tests identified differences in referral rates among categorical variables, while a generalised linear model (GLM) with an identity link (normal distribution) determined factors influencing referrals by physicians.FindingsAround 1 in 5 visits resulted in a referral (n = 210,839, 19.8%), achieving 76.0% attendance rate. Referrals peaked among patients aged 60–70 years. Male (Odds ratio [OR] 0.88, 95% Confidence interval [CI] 0.87–0.89) and Malay (OR 0.71, 95% CI 0.70–0.72, compared with Chinese) patients were less likely to be referred. Significant variations were observed among clinics (p InterpretationOur study highlighted disparities in referrals rates, patterns, and wait times. Continuing education and support for primary care is paramount. Resource allocation should be tailored to meet the population needs, with further research needed to ensure timely and appropriate referrals.