[Adequacy of medical referrals to hospital emergency service]. / Adecuación de las derivaciones médicas a un servicio de urgencias hospitalario.

OBJECTIVE: To assess the correctness and diagnostic concordance in referrals of patients to hospital Casualty Departments (CD); and the possible differences between rural and urban health centres (HC) as well as between general practitioners (GP) and family and community medicine (FCM) specialists. DESIGN: Observational study of a crossover nature. SETTING: Health area 1 in the province of Badajoz. PATIENTS AND OTHER PARTICIPANTS: 800 patients, referred to their local hospital Casualty Department. MEASUREMENTS AND MAIN RESULTS: 50.5% of all referrals were considered justified. 15.1% of the patients referred were admitted to hospital. 50.7% of referrals from GPs were found to be correct, against 47% from FCM specialists; and 49% of those referred from rural HCs were correct, as against 45.9% of those referred from urban HCs (no significant differences). Only 54% of referrals had a diagnostic hypothesis, with diagnostic concordance at 50%. There was diagnostic concordance in 28.1% of GP referrals, against 33.3% of FCM specialists; and in 27.5% of those from rural HCs against 26.1% from urban HCs (no significant differences). CONCLUSIONS: We found no differences in the correctness of referrals or diagnostic concordance of patients seen in the CD of our city's health area, neither between patients referred from rural and urban HCs, nor between patients referred by GPs and FCM specialists.

[Compliance with the new model referral forms from primary care to hospital emergency services]. / Cumplimentación de los nuevos modelos de derivación desde atención primaria a los servicios de urgencia hospitalarios.

OBJECTIVE: To evaluate the compliance with the new model forms for referral to hospital emergency services and possible differences between urban and rural health centres, and among general practitioners and family & community medicine specialists. DESIGN: An observational, crossover study. SETTING: Health Area 1 in the province of Badajoz. PARTICIPANTS: 800 new model forms for referral, equivalent to the same number of patients, sent to the casualty department of the referral hospital. MEASUREMENTS AND MAIN RESULTS: 76.7% of the referrals came from the rural environment, and the other 23.3% from urban health centres. Gathering anamnesis and symptoms is the only criterion which exceeds 90% of the recording in both rural and urban settings, and among general practitioners and family medicine specialists. Only 23.9% of referrals (23.8% in rural health centres and 22.7% in urban ones) met the four criteria which were considered indispensable for a minimum level of compliance. These percentages were 23.2% and 31.7% when broken down for general practitioners and family medicine specialists (no significant differences). CONCLUSIONS: There was a low level of compliance with the new model form for referral: there were no statistically significant differences in compliance between rural and urban health centres, nor between general practitioners and family & community medicine specialists.