RESUMO
The quantity of referrals to secondary care is increasing. That the quality of medical referrals is decreasing is a common allegation yet has rarely been assessed. We report a time-limited, cross-sectional survey evaluating cardiological referral information quality. Referral letters (n = 218, excluding direct access pro formas) from GPs to the Cardiology Department at City Hospital, Birmingham, were collated and analysed over 2 months. A subset (n = 49) of these patients completed questionnaires assessing their knowledge and patient communication of the referral. Information quality was poor (length, diagnosis, expectation, prior treatment and investigation) with almost half of all letters containing only outline symptomatic complaints without diagnosis. The majority of patients referred had not been investigated or treated in any way before referral. Despite lack of understanding of the reason for referral, typically the majority of patients expressed themselves as satisfied with the process. Given most referrals are seen as appropriate, information exchange between secondary and primary care is crucial. By contrast, the standard of even basic clinical assessment communicated between primary care and secondary care was severely limited. The reason(s) why medical assessment is lacking are unclear but must be explored to give more support to primary care to complete basic medical task particularly if investment is to flow into this source.
Assuntos
Serviço Hospitalar de Cardiologia , Doenças Cardiovasculares/diagnóstico , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Encaminhamento e Consulta/normas , Inglaterra , Medicina de Família e Comunidade/normas , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , MasculinoRESUMO
El objetivo es describir y analizar como parte del proceso privatizador, la evolución de los seguros médicos privados, a partir de los cambios iniciados a principios de la década pasada. Interesa fundamentalmente hacer un análisis de carácter político basado en datos económicos, pero subrayando el perfil político y de modificación de las relaciones de poder que han caracterizado al proceso de privatización de la atención médica en México desde 1982 hasta la fecha.
Assuntos
Assistência Médica/tendências , Seguradoras , Privatização/tendências , América Latina , México , Previdência Social/tendências , Saúde Pública/tendênciasRESUMO
El objetivo es describir y analizar como parte del proceso privatizador, la evolución de los seguros médicos privados, a partir de los cambios iniciados a principios de la década pasada. Interesa fundamentalmente hacer un análisis de carácter político basado en datos económicos, pero subrayando el perfil político y de modificación de las relaciones de poder que han caracterizado al proceso de privatización de la atención médica en México desde 1982 hasta la fecha.(AU)
