[ The family physician's sentinel function studied with reference to referrals and referral cards]

To study the gatekeeper function of Dutch general practitioners (GPs) by investigating the relation between the referring GP, referrals, and referral cards. (In the Netherlands, it is customary that patients only see a specialist after referral by their GP. In this way the GP acts as a gatekeeper between primary and secondary care. Specialists are paid by the patient's insurance company which they send a so-called referral card stating the name of the referring GP.)

Descriptive.

Hospitals in Groningen and Hoogeveen and four general practices in the area.

The study questions were answered using data for 1993 of the computerized morbidity Registration Network Groningen (RNG) of the Department of Family Medicine of Groningen University and data of two regional health insurance companies (RZG and Het Groene Land).

For 1993 the RNG showed a referral-referral card ratio of 34%, ranging from 24% to 42% among different practices; and from 17-46% among the various specialties. For the surgical specialties, the range of indications for which patients were actively referred to the various specialties varied from 21-33 per 100 referrals, for the non-surgical specialties it ranged from 25 to 56 per 100 referrals. The number of referrals by the 'own' GP accounted for an average of three-quarters of the referral cards attributed to the own GP. The last five years the number of referrals varied showing no clear increase or decrease.

GPs appeared to have difficulty in acting as gatekeeper once patients were being treated by the specialist. In studies of referrals. research into specialists' follow-up strategies should be an integral part. A back referral or return card could facilitate this type of study.