[Reasons and determining factors for referrals between primary and specialised care]. / Motivos y condicionantes de la interconsulta entre atención primaria y especializada.

OBJECTIVES: To determine the reasons and characteristics of referrals from Primary to Specialised Care in the Health Area of Toledo (Spain). MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted by reviewing a sample of the referrals to specialists made by 26 general practitioners from eight Teaching Health Centres during February 2011. All of them completed a questionnaire which recorded patient data, and reason and characteristics of the referral. RESULTS: A total of 332 referrals were recorded; the mean age of the patients was 51.3 years (SD; 17.9); 60.1% females; 30.7% pensioners; 54.8% had a chronic disease; 85.8% were from an urban environment. The most consulted specialists were: Traumatology (63), Gynaecology (53), and Ophthalmology (41). More than three-quarters (78.9%) were by the normal route, and 47.4% were first consultations. Around 12.7% were scheduled reviews, with a majority (51.4%) by a hospital specialist. More than two thirds (69.8%, 95% CI; 64.5-74.7%) required follow-up or treatment by the specialist. More than half (57.7%, 95% CI; 52.3-63.1%) required special diagnostic tests, and in 29.8% (95% CI; 25.0-35.1%) there was no clear diagnosis. There was a history of a repeated consultation for the same symptomatology in 28.9% of the referrals. Around 38.4% (95% CI; 33.0-43.7%) were requested specifically by the family or patient. Around 5.4% had a poor relationship with the patient. CONCLUSIONS: The majority of referrals are made by the normal route, and to surgical specialities. The need for hospital specialist follow-up and/or treatment, or the impossibility to request specific tests from Primary Care were the main reasons for requesting care from a second health care level. There were a high percentage of referrals requested by the family/patient.

Motivos y condicionantes de la interconsulta entre atención primaria y especializada / Reasons and determining factors for referrals between primary and specialised care

Objetivos. Conocer los motivos y características de las derivaciones desde atención primaria a especializada en el área de Salud de Toledo. Material y métodos. Estudio de tipo descriptivo transversal. Se revisó una muestra de las interconsultas a especializada realizadas por 26 médicos de familia, pertenecientes a 8 centros de salud docentes, en febrero de 2011. Por cada una, se cumplimentó un cuestionario que recogía datos del paciente, motivo y características de la derivación. Resultados. Se recogieron 332 interconsultas; la edad media de los pacientes fue de 51,3 años (DE 17,9); el 60,1% mujeres; el 30,7% pensionistas; el 54,8% presentaban patología crónica; el 85,8% procedía del medio urbano. Las especialidades más consultadas fueron: Traumatología (63), Ginecología (53) y Oftalmología (41). El 78,9% fueron vía normal y 47,4% fueron primeras consultas. Un 12,7% eran revisiones programadas, en su mayoría (51,4%) por el especialista hospitalario. El 69,8% (IC95% 64,5–74,7%) precisaba seguimiento o tratamiento por el especialista. El 57,7% (IC95% 52,3–63,1%) requería pruebas diagnósticas especiales. En el 29,8% (IC95% 25,0–35,1%) no estaba claro el diagnóstico. En el 28,9% de las derivaciones había antecedentes de consulta reiterada por esa sintomatología. En el 38,4% (IC95% 33,0–43,7%) hubo solicitud expresa por familia o paciente. El 5,4% tenía mala relación con el paciente. Conclusiones. La mayoría de las derivaciones se hacen por vía normal y a especialidades quirúrgicas. La necesidad de seguimiento y/o tratamiento por parte del especialista hospitalario o la imposibilidad de solicitar determinadas pruebas desde atención primaria fueron los principales motivos para solicitar la atención del segundo nivel asistencial. Existe un alto porcentaje de interconsultas inducidas por la familia/paciente(AU)

Objectives. To determine the reasons and characteristics of referrals from Primary to Specialised Care in the Health Area of Toledo (Spain). Material and methods. A descriptive, cross-sectional study was conducted by reviewing a sample of the referrals to specialists made by 26 general practitioners from eight Teaching Health Centres during February 2011. All of them completed a questionnaire which recorded patient data, and reason and characteristics of the referral. Results. A total of 332 referrals were recorded; the mean age of the patients was 51.3 years (SD; 17.9); 60.1% females; 30.7% pensioners; 54.8% had a chronic disease; 85.8% were from an urban environment. The most consulted specialists were: Traumatology (63), Gynaecology (53), and Ophthalmology (41). More than three-quarters (78.9%) were by the normal route, and 47.4% were first consultations. Around 12.7% were scheduled reviews, with a majority (51.4%) by a hospital specialist. More than two thirds (69.8%, 95% CI; 64.5–74.7%) required follow-up or treatment by the specialist. More than half (57.7%, 95% CI; 52.3–63.1%) required special diagnostic tests, and in 29.8% (95% CI; 25.0-35.1%) there was no clear diagnosis. There was a history of a repeated consultation for the same symptomatology in 28.9% of the referrals. Around 38.4% (95% CI; 33.0–43.7%) were requested specifically by the family or patient. Around 5.4% had a poor relationship with the patient. Conclusions. The majority of referrals are made by the normal route, and to surgical specialities. The need for hospital specialist follow-up and/or treatment, or the impossibility to request specific tests from Primary Care were the main reasons for requesting care from a second health care level. There were a high percentage of referrals requested by the family/patient(AU)