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[Reasons for consultation between primary care and the second level]
F J Rodríguez Alcalá1, J Chacón Fuertes, M Esteban Tudela
1Gerencia de Atención Primaria de Toledo, Centro de Salud de Palomarejos, Barcelona, Toledo, España. jrodriguez@sescam.org
Objective:
To identify the reasons causing most referrals from primary care to specialist clinics in our health area. In addition, we analysed the quality of compliance in the inter-clinic forms.
Design:
Descriptive and observational study.
Setting:
Primary care in the Toledo Health Area.
Population:
Inter-clinic forms (ICF) issued by doctors in 17 primary care teams (PCTs) during 2 weeks in November 2002. Measurements. Age and sex of patient, PCT, type of referral (first time, check-up), referral path (normal, preferential), specialty, reason for referral, ICF quality.
Main Results:
1610 ICFs from 125 doctors were analysed. 64.6% belonged to women. Average age was 43.5 (95% confidence interval [CI], 42.4-44.6). 74.6% (95% CI, 72.2-76.5) were new consultations. 12.9% (95% CI, 11.3-14.7) were preferential referrals. Specialties with most referrals were: Gynaecology (20.2%), traumatology (17.4%), and Ophthalmology (14.9%). The early diagnosis of gynaecological cancer (13.01%; 95% CI, 11.4-14.8), reduction in visual sharpness (6.95%; 95% CI, 5.8-8.3) and benign skin tumours (4.18%; 95% CI, 3.3-5.3) were the 3 reasons for most referrals. ICF quality was thought good in 13.1% of cases, acceptable in 82.8%, and poor in 4.1%.
Conclusions:
A high number of referrals were due to reasons that could be resolved at the primary care level. Most inter-clinical referrals were to medical-surgical specialists. Inter-clinical forms are still open to considerable improvement.
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