[Does the communication between primary and secondary levels function?]. / Funciona la comunicación entre los niveles primario y secundario?

OBJECTIVE: To analyse the quality of information transmitted by the interclinical form (DI-1) between primary and secondary care levels; and the frequency and causes of the primary care doctor's not receiving a reply. DESIGN: Descriptive and blind for the doctors taking part. SETTING: Seven health centres and 12 specialist out-clinics in the Bizkaia Health region. PARTICIPANTS: The DIs issued by 43 general practitioners and answers from the specialists. INTERVENTIONS: We recorded all the referrals during a 7-day period (18-26 April 1994). After the normal waiting time we went to the centres to collect the returned DIs. Patients whose form was not found in the records were phoned. Five people (3 family doctors: one as Director and two specialists) evaluated the DI, in line with established criteria. RESULTS: Information was lost in 78% of the total number of referrals. The main cause was the specialist not replying (50.7%); the second, the route the form took and the patient (20.9%). The quality of information of the DI analysed was good/acceptable in 92.5% of those issued and in 90% of replies. CONCLUSIONS: The high percentage loss of information was mainly due to the specialist and, secondly, to the route taken and patient. We recommended the introduction of internal mail between both levels and a study of the attitudes and expectations of the professionals concerned in order to improve the interrelationship and quality of health provision.

[Hospital emergency service utilization by the population from a primary health center: level of suitability]. / Estudio de la utilización de servicios de urgencias hospitalarios por la población de un EAP: grado de adecuación.

A descriptive study on hospital record corresponding to 379 patients over 14 years, from the Health Center of Rekaldeberri (Bilbao), who attended any of the hospital emergency services available in the province, during the last quarter of 1989 is presented. Objectives were to identify circumstances that motivated consultation, and its apropriateness. Data were recorded by family doctors. As much as 76% of them attended on one's own initiative being this proporcion larger among the youngest. The most frequent diagnosis was the one that corresponded to "Accidents, injuries, poisoning, and violence", 37.5% of the total. 20.8% of the patients were admitted to the hospital. We considered consultation to be apropriate 55.1% of the times, with larger percentages among those who were sent by family doctors (91.1%) and those advanced in years. Lastly data are compared to other studies and we make some considerations about primary health care's responsibility for massification of hospital emergency services.