[Comparison of the place of origin of the referral of patients to hospital emergency service]

Abstract

Objectives: To find the clinical and epidemiological differences in the place of origin (rural or urban) of patients attending a hospital Casualty Department (HCD) referred by a doctor. To detect problems in urgent non-hospital medical care, especially in rural areas.

Design: A descriptive crossover study.

Setting: "Centro" Health District, Sevilla.

Participants: Patients referred to HCDs during 1995: Rural (R) = 3,521; Urban (U) = 13,203.

Measurements: The variables recorded for both groups were: age, sex, frequency of attendance, referral, diagnosis and destination of the patient.

Results: The urban population had a higher rate of attendance (131.8 visits per 1,000 inhabitants) than the rural (67.5). The percentage of referrals was greater from R (p < 0.001), although the proportion of population covered was similar. Age was similar, with more males from R. Abdominal and precordial pain and foreign bodies were the symptoms with most referrals from R; ear-ache, dizzy spells, minor surgery and fainting were from U.

Conclusions: HCD is used to the same extent by R and U. More and better selected referred patients came from R. The rural doctor is the first to attend both serious and trivial pathology, whereas in the urban milieu the seriously ill patient goes straight to hospital.