Table 2.

Summary of task and patient complexity in relation to referrals from general practice to cardiology

Type of complexityCategory/level of complexity, low, high, variable, mixeda
DescriptionComponentsAffluent areaDeprived area
Task complexity
Task sizeMultiple goals, multiple options, excess informationLOW: Usually explicit task, focused informationHIGH: Difficulty unpicking information and prioritising for health gain
Task noveltyLack of experienceVARIABLE: GPs knowledge of the local systems and clinical experience will be variableVARIABLE: GPs knowledge of the local systems and clinical experience will be variable
Task ambiguityUnclear goals, confusing informationLOW: Patient expectation dictates GP actionHIGH: GPs seek to engage patient
RelationshipsConflicting goals, decision conflictHIGH: Patient wish versus defensive versus. resource useHIGH: Imperative to treat versus patient fear/reluctance versus resource use
Action complexityLack of coordination, information flowLOW: Clear lines of communication, option of private referral for someHIGH: Events above patients’ health literacy level
VariabilityChanging informationLOW: Patients report concerns promptlyHIGH: Patients often accept deterioration rather than notify GPs/seek help
TemporalTime pressureHIGH: PresentHIGH: Present
Patient complexity
Physical healthMultimorbidity, polypharmacyLOW: Few other conditions, controlledHIGH: Multiple comorbid conditions
Mental healthAnxiety, other illness, substance dependencyMIXED: Anxiety drives referral for someMIXED: Anxiety drives referral for some
DemographicsAge, socioeconomic, ethnicityMIXED: Older but independentHIGH: Younger but sicker, challenge of continuing to be economically active
Social capitalPoverty, low social support, high treatment burdenLOW: High social capital, networks of support and advocacyHIGH: Low social capital, variable support but little advocacy
Health and social experiencesHeavy use of resource, difficulty navigating systemsLOW: Adept at using and choosing systems as consumersHIGH: Need assistance (sometimes ongoing) to navigate systems. Safety nets are less likely to work
  • a Categories/levels of complexity taken from Islam et al.25 High complexity = a task or patient presentation which is intricate and complicated. Variable complexity = a task which can vary in difficulty for different groups or the same group at different times. Mixed complexity = a ‘mixture’ of patients present with different characteristics of complexity. Low complexity: a task which is more explicit and simple.