[An analysis of the interrelations of primary care-specialized care in patient referral]

Abstract

Objective: To examine communication between primary care doctors and specialists on the question of patient referral.

Design: It was a prospective, longitudinal three-month long study, using observation and without a control.

Setting: Within Health Area II in Zaragoza, at the Rebolería, Oviedo and Seminario Primary Health Care centres (PCC) and the Ramón y Cajal specialist centre.

Patients: 265 referrals during a month from the three PCC's to three specialist departments, Trauma, Neurology and Urology. The selection criterion for the referrals was the use of the internal mail system to make appointments at the specialist centre.

Measurements and main results: 85% of the patients referred to specialists had a Clinical History in Primary Care. Of the three specialties examined, the Trauma Clinic received 63.7% of the referrals. The average time elapsed from referral to receiving back the information was 34 days (+/- 20) for those patients who completed the cycle.

Conclusions: The study identified both a large number of "mislaid" patients and a low level of information fed back to the Primary Care doctors, for example reports not containing a diagnosis or the treatment to be followed. This leads us to think that the absence of a work-system which facilitates the inter-professional relationship of the doctors at these two care levels makes the follow-up and treatment of patients more difficult and in general lowers the standards of health care.