ABSTRACT
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Subject(s)
Humans , Waiting Lists , Waiting Lists , Referral and Consultation , Primary Health Care , Practice Management, Medical , Referral and ConsultationABSTRACT
OBJECTIVE: Analysis of the results obtained in terms of improvement in the continuity of care, its resolutive capacity and accessibility, in the framework of the organisational change brought about by the reorganisation of specialist care (RSC) in the Ciutat Vella Health Sector. DESIGN: A descriptive study of the reorganised model of specialist care introduced in 1995 and comparison between this and the previous model (1993) in terms of activity, further tests made, referral to hospital, filling in the clinical history and waiting-list. T SETTING: The experience involved 4 PCTs in the Ciutat Vella Health sector of Barcelona (covering 74,449 people). MEASUREMENTS AND MAIN RESULTS: The volume of visits was in general less in 1995, while other types of activity had been incorporated: minor surgery, cryotherapy, consultations and sessions. CONCLUSIONS: The model of RSC satisfies the basic objectives for which it was designed. It increased the specialist's ability to resolve the case within Primary Care. It improved user accessibility to specialist care in terms of waiting time. Finally, the model favours ongoing care, thanks to a single clinical history for both levels.
Subject(s)
Continuity of Patient Care , Health Services Accessibility , Medicine , Specialization , Humans , SpainABSTRACT
BACKGROUND: In order to improve the health quality at the Primary care level, the Catalonian Health Authority (Servei Catala de la Salut) has begun a reform of the medical and surgical specialties. In this reform process the Hospital del Mar, Barcelona, Spain, has taken part in the incorporation of several medical and surgical hospital specialists to primary care within its influence area. In this study, we describe the results of the collaboration between Hospital health care and Primary care on rheumatic complaints during one year. METHODS: We carried out a descriptive study of some clinical and epidemiological variables of the population visited during one year (1995), at the Primary care level by the Rheumatologist. Our area has a population of 90,612 people, and its located in Barcelona City, Ciutat Vella Variables of study were collected during the period of time between January and December 1995. The following variables were recorded: age, gender, referral cause, rheumatologic diagnosis, intra-articular and peri-articular corticosteroid injections perform, techniques used for the diagnosis of rheumatic disease, follow-up level Data were statistically analyzed. RESULTS: Visits performed were 2,668 on 1,384 patients. Fifty-two percent were first visits, 48% were follow-up visits (Ratio first visits Nolfow-up visits: 0.57). Fifty-one percent of the patients were > 65 years old. Unspecific polyarthralgias, chronic low back pain, gonalgia and pathology of the shoulder were the most frequent complaints (> 50%). Osteoarthritis and soft-tissue diseases were the most frequent diagnosis with a percentage of 41% and 30.7%, respectively. Connective tissue diseases and spondyloarthropathies had account for 3.8% of global diagnosis. X-ray film has been the commonest technique used for the diagnosis of rheumatic diseases (80.5%). The waiting list for first visit initially has been 5 weeks, and at the end of study it has been 3 weeks. Ten percent of patients had been referred to the Hospital. CONCLUSIONS: Collaboration between Hospital care rheumatology and Primary care, improves the diagnostic quality, as well as it decreases the waiting list and allows the patients' control at the most appropriate care level.